Perkutane Mitralklappenrekonstruktion bei schwerer Mitralinsuffizienz nach Mitralklappenannuloplastie: MitraClip-in-the-ring als ergänzende Strategie

Translated title of the contribution: Percutaneous mitral valve repair in recurrent severe mitral valve regurgitation after mitral annuloplasty: MitraClip-in-the-ring as a complementary strategy

Sven T. Pleger, Nicolas Geis, Michael Kreusser, Haitham Abu-Sharar, Christian Sebening, Gabor Szabo, Hugo A. Katus, Philip W.J. Raake

Research output: Contribution to journalArticle

Abstract

Background: Patients with reduced left ventricular (LV) function undergoing coronary artery bypass graft surgery or/and aortic valve replacement occasionally show severe mitral valve (MV) regurgitation and thus also undergo surgical mitral annuloplasty. Over time, further deterioration of LV function and additional ischemic events cause recurrence of severe MV regurgitation due to the Carpentier IIIb morphology of the MV that is not adequately addressed by the previously implanted annuloplasty ring. Methods: Seven patients (Society of Thoracic Surgeons score: 7.5 ± 1.5%) with Carpentier type-IIIb recurrent severe MV regurgitation, having undergone prior cardiothoracic surgery (median: 40 months) including mitral annuloplasty, were treated with the MitraClip device. Results: MitraClip implantation resulted in significantly reduced MV regurgitation and improved New York Heart Association functional state, translating into an increased exercise capability and improved cardiac biomarkers. The morphology of the MV was adequately addressed without causing relevant MV stenosis, while the MV annulus area remained unaltered. The procedure was safe with a 30-day mortality rate of 0%. Conclusion: MitraClip-in-the-ring is feasible and in principle safe for treating Carpentier type IIIb severe MV regurgitation after surgical MV repair using mitral annuloplasty. MitraClip-in-the-ring resulted in immediate amelioration of clinical symptoms and increased physical exercise capacity.

Original languageGerman
JournalHerz
DOIs
Publication statusAccepted/In press - Jan 1 2019

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Mitral Valve Annuloplasty
Mitral Valve Insufficiency
Mitral Valve
Left Ventricular Function
Exercise
Mitral Valve Stenosis
Aortic Valve
Surgical Instruments
Coronary Artery Bypass
Biomarkers
Transplants
Recurrence
Equipment and Supplies
Mortality

Keywords

  • Exercise
  • Heart valve prosthesis
  • Mitral valve insufficiency
  • Mitral valve stenosis
  • Ventricular function, left

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Perkutane Mitralklappenrekonstruktion bei schwerer Mitralinsuffizienz nach Mitralklappenannuloplastie : MitraClip-in-the-ring als ergänzende Strategie. / Pleger, Sven T.; Geis, Nicolas; Kreusser, Michael; Abu-Sharar, Haitham; Sebening, Christian; Szabo, Gabor; Katus, Hugo A.; Raake, Philip W.J.

In: Herz, 01.01.2019.

Research output: Contribution to journalArticle

Pleger, Sven T. ; Geis, Nicolas ; Kreusser, Michael ; Abu-Sharar, Haitham ; Sebening, Christian ; Szabo, Gabor ; Katus, Hugo A. ; Raake, Philip W.J. / Perkutane Mitralklappenrekonstruktion bei schwerer Mitralinsuffizienz nach Mitralklappenannuloplastie : MitraClip-in-the-ring als ergänzende Strategie. In: Herz. 2019.
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abstract = "Background: Patients with reduced left ventricular (LV) function undergoing coronary artery bypass graft surgery or/and aortic valve replacement occasionally show severe mitral valve (MV) regurgitation and thus also undergo surgical mitral annuloplasty. Over time, further deterioration of LV function and additional ischemic events cause recurrence of severe MV regurgitation due to the Carpentier IIIb morphology of the MV that is not adequately addressed by the previously implanted annuloplasty ring. Methods: Seven patients (Society of Thoracic Surgeons score: 7.5 ± 1.5{\%}) with Carpentier type-IIIb recurrent severe MV regurgitation, having undergone prior cardiothoracic surgery (median: 40 months) including mitral annuloplasty, were treated with the MitraClip device. Results: MitraClip implantation resulted in significantly reduced MV regurgitation and improved New York Heart Association functional state, translating into an increased exercise capability and improved cardiac biomarkers. The morphology of the MV was adequately addressed without causing relevant MV stenosis, while the MV annulus area remained unaltered. The procedure was safe with a 30-day mortality rate of 0{\%}. Conclusion: MitraClip-in-the-ring is feasible and in principle safe for treating Carpentier type IIIb severe MV regurgitation after surgical MV repair using mitral annuloplasty. MitraClip-in-the-ring resulted in immediate amelioration of clinical symptoms and increased physical exercise capacity.",
keywords = "Exercise, Heart valve prosthesis, Mitral valve insufficiency, Mitral valve stenosis, Ventricular function, left",
author = "Pleger, {Sven T.} and Nicolas Geis and Michael Kreusser and Haitham Abu-Sharar and Christian Sebening and Gabor Szabo and Katus, {Hugo A.} and Raake, {Philip W.J.}",
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AU - Pleger, Sven T.

AU - Geis, Nicolas

AU - Kreusser, Michael

AU - Abu-Sharar, Haitham

AU - Sebening, Christian

AU - Szabo, Gabor

AU - Katus, Hugo A.

AU - Raake, Philip W.J.

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N2 - Background: Patients with reduced left ventricular (LV) function undergoing coronary artery bypass graft surgery or/and aortic valve replacement occasionally show severe mitral valve (MV) regurgitation and thus also undergo surgical mitral annuloplasty. Over time, further deterioration of LV function and additional ischemic events cause recurrence of severe MV regurgitation due to the Carpentier IIIb morphology of the MV that is not adequately addressed by the previously implanted annuloplasty ring. Methods: Seven patients (Society of Thoracic Surgeons score: 7.5 ± 1.5%) with Carpentier type-IIIb recurrent severe MV regurgitation, having undergone prior cardiothoracic surgery (median: 40 months) including mitral annuloplasty, were treated with the MitraClip device. Results: MitraClip implantation resulted in significantly reduced MV regurgitation and improved New York Heart Association functional state, translating into an increased exercise capability and improved cardiac biomarkers. The morphology of the MV was adequately addressed without causing relevant MV stenosis, while the MV annulus area remained unaltered. The procedure was safe with a 30-day mortality rate of 0%. Conclusion: MitraClip-in-the-ring is feasible and in principle safe for treating Carpentier type IIIb severe MV regurgitation after surgical MV repair using mitral annuloplasty. MitraClip-in-the-ring resulted in immediate amelioration of clinical symptoms and increased physical exercise capacity.

AB - Background: Patients with reduced left ventricular (LV) function undergoing coronary artery bypass graft surgery or/and aortic valve replacement occasionally show severe mitral valve (MV) regurgitation and thus also undergo surgical mitral annuloplasty. Over time, further deterioration of LV function and additional ischemic events cause recurrence of severe MV regurgitation due to the Carpentier IIIb morphology of the MV that is not adequately addressed by the previously implanted annuloplasty ring. Methods: Seven patients (Society of Thoracic Surgeons score: 7.5 ± 1.5%) with Carpentier type-IIIb recurrent severe MV regurgitation, having undergone prior cardiothoracic surgery (median: 40 months) including mitral annuloplasty, were treated with the MitraClip device. Results: MitraClip implantation resulted in significantly reduced MV regurgitation and improved New York Heart Association functional state, translating into an increased exercise capability and improved cardiac biomarkers. The morphology of the MV was adequately addressed without causing relevant MV stenosis, while the MV annulus area remained unaltered. The procedure was safe with a 30-day mortality rate of 0%. Conclusion: MitraClip-in-the-ring is feasible and in principle safe for treating Carpentier type IIIb severe MV regurgitation after surgical MV repair using mitral annuloplasty. MitraClip-in-the-ring resulted in immediate amelioration of clinical symptoms and increased physical exercise capacity.

KW - Exercise

KW - Heart valve prosthesis

KW - Mitral valve insufficiency

KW - Mitral valve stenosis

KW - Ventricular function, left

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