Factors influencing post-surgical survival in degenerative mitral regurgitation DOI Open Access
Steele C. Butcher, Benjamin Essayagh, Ewout W. Steyerberg

et al.

European Heart Journal, Journal Year: 2023, Volume and Issue: 44(10), P. 871 - 881

Published: Jan. 26, 2023

Abstract Aims Indications for surgery in patients with degenerative mitral regurgitation (DMR) are increasingly liberal all clinical guidelines but the role of secondary outcome determinants (left atrial volume index ≥60 mL/m2, fibrillation, pulmonary artery systolic pressure ≥50 mmHg and moderate to severe tricuspid regurgitation) their impact on post-operative remain disputed. Whether these markers just reflective DMR severity or intrinsically affect survival after is uncertain may have critical importance management DMR. To address gaps knowledge present study gathered a large cohort quantified DMR, accounted number examined independent surgical correction Methods results The Mitral Regurgitation International DAtabase-Quantitative registry includes isolated from centres across North America, Europe, Middle East. Patient enrolment extended January 2003 2020. All undergoing valve within 1 year were selected. A total 2276 [65 (55–73) years, 32% male] five met eligibility criteria. Over median follow-up 5.6 (3.6 8.7) 278 (12.2%) died. In comprehensive multivariable Cox regression model adjusted age, EuroSCORE II, symptoms, left ventricular ejection fraction (LVEF), end-systolic diameter (LV ESD) severity, was independently associated all-cause mortality, hazard ratios 1.56 [95% confidence interval (CI): 1.11–2.20, P = 0.011], 1.78 (95% CI: 1.23–2.58, 0.002) 2.58 1.73–3.83, < 0.0001) one, two, three four determinants, respectively. incorporating demonstrated higher C-index significantly more concordant mortality than models traditional Class I indications alone [the presence symptoms (P 0.0003), LVEF ≤60% 0.006), LV ESD ≥40 mm 0.014)], while there no significant difference concordance observed compared that incorporated combined 0.71). Conclusion this treated surgically post-surgical better discrimination surgery. Randomised controlled trials needed determine if who demonstrate cardiac phenotype an increasing would benefit earlier

Language: Английский

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association DOI Creative Commons
Seth S. Martin, Aaron W. Aday, Zaid Almarzooq

et al.

Circulation, Journal Year: 2024, Volume and Issue: 149(8)

Published: Jan. 24, 2024

BACKGROUND: The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, obesity) factors (cholesterol, blood pressure, glucose control, metabolic syndrome) that contribute health. AHA Disease Stroke Statistical Update presents latest data on a range major clinical circulatory disease conditions (including brain health, complications pregnancy, kidney congenital rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary cardiomyopathy, failure, valvular venous thromboembolism, peripheral artery disease) associated outcomes quality care, procedures, economic costs). METHODS: AHA, through its Epidemiology Prevention Statistics Committee, continuously monitors evaluates sources stroke United States globally provide current information available annual review published literature year before writing. 2024 is product full year’s worth effort 2023 by dedicated volunteer clinicians scientists, committed government professionals, staff members. strives further understand help heal problems inflicted structural racism, public crisis can significantly damage mental perpetuate disparities access education, income, housing, several other vital healthy lives. This edition includes additional global data, as well monitoring benefits population, an enhanced focus equity across key domains. RESULTS: Each chapters focuses different topic statistics. CONCLUSIONS: represents critical resource for lay public, policymakers, media clinicians, care administrators, researchers, advocates, others seeking best these conditions.

Language: Английский

Citations

914
Tricuspid regurgitation: recent advances in understanding pathophysiology, severity grading and outcome DOI Open Access
Rebecca T. Hahn, Luigi P. Badano, Philipp E. Bartko

et al.

European Heart Journal - Cardiovascular Imaging, Journal Year: 2022, Volume and Issue: 23(7), P. 913 - 929

Published: Jan. 12, 2022

Heightened interest in tricuspid regurgitation (TR) stems from the consistent association of mortality with greater severity TR, and a low use surgical solutions setting high in-hospital attributed to late presentation disease. The delay intervention is likely related limited understanding valvular/ventricular anatomy disease pathophysiology, along an underestimation TR by standard imaging modalities. With rapid development transcatheter which have shown early safety efficacy, there growing need understand accurately diagnose valvular process order determine appropriate management solutions. current review will describe both normal pathologic anatomy, classification these anatomic substrates strengths limitations guidelines-recommended multi-parametric echocardiographic approach role multi-modality imaging, as well device therapy

Language: Английский

Citations

161
Transfemoral tricuspid valve replacement and one-year outcomes: the TRISCEND study DOI Open Access
Susheel Kodali, Rebecca T. Hahn, Raj Makkar

et al.

European Heart Journal, Journal Year: 2023, Volume and Issue: 44(46), P. 4862 - 4873

Published: Nov. 1, 2023

For patients with symptomatic, severe tricuspid regurgitation (TR), early results of transcatheter valve (TV) intervention studies have shown significant improvements in functional status and quality life associated right-heart reverse remodelling. Longer-term follow-up is needed to confirm sustained these outcomes.

Language: Английский

Citations

106
Tricuspid Valve Academic Research Consortium Definitions for Tricuspid Regurgitation and Trial Endpoints DOI Creative Commons
Rebecca T. Hahn, Matthew Lawlor,

Charles J. Davidson

et al.

Journal of the American College of Cardiology, Journal Year: 2023, Volume and Issue: 82(17), P. 1711 - 1735

Published: Oct. 1, 2023

Interest in the pathophysiology, etiology, management, and outcomes of patients with tricuspid regurgitation (TR) has grown wake multiple natural history studies showing progressively worse associated increasing TR severity, even after adjusting for comorbidities. Historically, isolated valve surgery been high in-hospital mortality rates, leading to development transcatheter treatment options. The aim this first Tricuspid Valve Academic Research Consortium document is standardize definitions disease etiology as well endpoints trials that address gaps our knowledge related identification management TR. Standardizing should provide consistency enable meaningful comparisons between clinical trials. A second will focus on further defining trial discuss design

Language: Английский

Citations

84
Contemporary Outcomes Following Transcatheter Edge-to-Edge Repair DOI Creative Commons
Saibal Kar, Ralph Stephan von Bardeleben, Wolfgang Rottbauer

et al.

КАРДИОЛОГИЯ УЗБЕКИСТАНА, Journal Year: 2023, Volume and Issue: 16(5), P. 589 - 602

Published: March 1, 2023

Language: Английский

Citations

65
Transcatheter Mitral Valve Repair for Degenerative Mitral Regurgitation DOI
Raj Makkar,

Joanna Chikwe,

Tarun Chakravarty

et al.

JAMA, Journal Year: 2023, Volume and Issue: 329(20), P. 1778 - 1778

Published: May 23, 2023

Importance There are limited data on the outcomes of transcatheter edge-to-edge mitral valve repair for degenerative regurgitation (MR) in a real-world setting. Objective To evaluate MR. Design, Setting, and Participants Cohort study consecutive patients Society Thoracic Surgeons/American College Cardiology Transcatheter Valve Therapies Registry who underwent nonemergent MR US from 2014 through 2022. Exposure with MitraClip device (Abbott). Main Outcomes Measures The primary end point was success, defined as moderate or less residual mean gradient than 10 mm Hg. Clinical were evaluated based degree (mild MR) gradients (≤5 Hg >5 to <10 Hg). Results A total 19 088 isolated severe analyzed (median age, 82 years; 48% women; median Surgeons predicted risk mortality surgical repair, 4.6%). success achieved 88.9% patients. At 30 days, incidence death 2.7%; stroke, 1.2%; reintervention, 0.97%. compared an unsuccessful procedure associated significantly lower (14.0% vs 26.7%; adjusted hazard ratio, 0.49; 95% CI, 0.42-0.56; P < .001) heart failure readmission (8.4% 16.9%; 0.47; 0.41-0.54; at 1 year. Among lowest observed had both mild 5 those (11.4% 0.40; 0.34-0.47; .001). Conclusions Relevance In this registry-based undergoing safe resulted successful low gradients.

Language: Английский

Citations

61
1-Year Outcomes With Fourth-Generation Mitral Valve Transcatheter Edge-to-Edge Repair From the EXPAND G4 Study DOI Creative Commons
Ralph Stephan von Bardeleben,

Paul Mahoney,

Michael A. Morse

et al.

КАРДИОЛОГИЯ УЗБЕКИСТАНА, Journal Year: 2023, Volume and Issue: 16(21), P. 2600 - 2610

Published: Oct. 24, 2023

The fourth-generation mitral transcatheter edge-to-edge repair (M-TEER) device introduced an improved clip deployment sequence, independent leaflet grasping, and 2 wider sizes to tailor the treatment of patients with regurgitation (MR) for a broad range anatomies. 30-day safety effectiveness M-TEER were previously demonstrated. aim this study was evaluate 1-year outcomes in contemporary, real-world cohort subjects treated MitraClip G4 system. EXPAND is ongoing prospective, multicenter, international, single-arm that enrolled primary secondary MR. One-year included MR severity (echocardiographic core laboratory assessed), heart failure hospitalization, all-cause mortality, functional capacity (NYHA class), quality life (Kansas City Cardiomyopathy Questionnaire). A total 1,164 underwent from 2020 2022. At 1 year, there durable reduction mild or less 92.6% none trace 44.2% (P < 0.0001 vs baseline). Few had major adverse events through year (<2% myocardial infarction, surgical reintervention, single-leaflet attachment). Kaplan-Meier estimates mortality hospitalization 12.3% 16.9%. Significant improvements class I II 82%; P baseline) (18.5-point Kansas Questionnaire overall summary score improvement; 0.0001) observed. safe effective at reductions ≤1+ more than 90% concomitant status life.

Language: Английский

Citations

50
Atrial secondary tricuspid regurgitation: pathophysiology, definition, diagnosis, and treatment DOI Creative Commons
Denisa Muraru, Luigi P. Badano, Rebecca T. Hahn

et al.

European Heart Journal, Journal Year: 2024, Volume and Issue: 45(11), P. 895 - 911

Published: March 5, 2024

Abstract Atrial secondary tricuspid regurgitation (A-STR) is a distinct phenotype of with predominant dilation the right atrium and normal left ventricular function. occurs most commonly in elderly women atrial fibrillation heart failure preserved ejection fraction sinus rhythm. In A-STR, main mechanism leaflet malcoaptation related to presence significant annulus enlargement. addition, there an insufficient adaptive growth valve leaflets that become unable cover enlarged annular area. As opposed phenotype, tethering typically trivial. The A-STR accounts for 10%–15% clinically relevant has better outcomes compared more prevalent phenotype. Recent data suggest patients may benefit from aggressive rhythm control timely interventions. However, little mentioned current guidelines on how identify, evaluate, manage these due lack consistent evidence variable definitions this entity recent investigations. This interdisciplinary expert opinion document focusing intended help physicians understand complex rapidly evolving topic by reviewing its pathophysiology, diagnosis, multi-modality imaging characteristics. It first defines proposing specific quantitative criteria defining discriminating it order facilitate standardization consistency research.

Language: Английский

Citations

45
Transcatheter Valve Replacement in Severe Tricuspid Regurgitation DOI
Rebecca T. Hahn,

Raj Makkar,

Vinod H. Thourani

et al.

New England Journal of Medicine, Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 30, 2024

BackgroundSevere tricuspid regurgitation is associated with disabling symptoms and an increased risk of death. Data regarding outcomes after percutaneous transcatheter tricuspid-valve replacement are needed.MethodsIn this international, multicenter trial, we randomly assigned 400 patients severe symptomatic in a 2:1 ratio to undergo either medical therapy (valve-replacement group) or alone (control group). The hierarchical composite primary outcome was death from any cause, implantation right ventricular assist device heart transplantation, postindex intervention, hospitalization for failure, improvement at least 10 points the score on Kansas City Cardiomyopathy Questionnaire overall summary (KCCQ-OS), one New York Heart Association (NYHA) functional class, 30 m 6-minute walk distance. A win calculated by comparing all possible patient pairs, starting first event hierarchy.ResultsA total 267 were valve-replacement group 133 control group. At 1 year, favoring valve 2.02 (95% confidence interval [CI], 1.56 2.62; P<0.001). In comparisons those had more wins than respect cause (14.8% vs. 12.5%), intervention (3.2% 0.6%), KCCQ-OS (23.1% 6.0%), NYHA class (10.2% 0.8%), distance (1.1% 0.9%). fewer annualized rate failure (9.7% 10.0%). Severe bleeding occurred 15.4% 5.3% (P=0.003); new permanent pacemakers implanted 17.4% 2.3%, respectively (P<0.001).ConclusionsFor regurgitation, superior outcome, driven primarily improvements quality life. (Funded Edwards Lifesciences; TRISCEND II ClinicalTrials.gov number, NCT04482062.)

Language: Английский

Citations

37
The Society of Thoracic Surgeons 2023 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation DOI Open Access

Moritz C. Wyler von Ballmoos,

Dawn S. Hui, J. Hunter Mehaffey

et al.

The Annals of Thoracic Surgery, Journal Year: 2024, Volume and Issue: 118(2), P. 291 - 310

Published: Jan. 27, 2024

Language: Английский

Citations

32