Abstract
Purpose of Review
To describe the key role of the structural imager/interventional echocardiographer in transcatheter mitral valve therapies, particularly edge-to-edge repair. In addition, we review important recent advances in structural imaging and briefly describe several novel devices for transcatheter mitral valve repair.
Recent Findings
Structural imagers represent a new subspecialty in cardiology and anesthesiology with specific skillset and training requirements. Their role is particularly important in imaging-based transcatheter interventions such as edge-to-edge mitral valve repair. This therapy has increasingly been used to treat primary (degenerative) mitral regurgitation when surgical risk is prohibitive and has recently been extended to patients with secondary (functional) mitral regurgitation. As novel transcatheter therapies continue to emerge, so do new multimodality imaging technologies.
Summary
Structural imagers have become an integral part of the heart team. Their role is particularly visible in transcatheter mitral procedures. Rapidly developing transcatheter therapies have helped shape this new subspecialty and spark innovation in imaging technologies.
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References
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Fernando RJ, Shah R, Yang Y, Goeddel LA, Villablanca PA, Gil IJN, et al. Transcatheter mitral valve repair and replacement: analysis of recent data and outcomes. J Cardiothorac Vasc Anesth. 2020. https://doi.org/10.1053/j.jvca.2020.01.009.
Guerrero M, Vemulapalli S, Xiang Q, Wang DD, Eleid M, Cabalka AK, et al. Thirty-day outcomes of transcatheter mitral valve replacement for degenerated mitral bioprostheses (valve-in-valve), failed surgical rings (valve-in-ring), and native valve with severe mitral annular calcification (valve-in-mitral annular calcification) in the United States: data from the Society of Thoracic Surgeons/American College of Cardiology/Transcatheter Valve Therapy Registry. Circ Cardiovasc Interv. 2020;13(3):e008425. https://doi.org/10.1161/CIRCINTERVENTIONS.119.008425.
Abbott. Abbott receives U.S. approval of next-generation Mitraclip™, bringing new enhancements to Abbott’s leading Mitraclip platform.
Wang DD, Geske J, Choi AD, Khalique O, Lee J, Atianzar K, et al. Navigating a career in structural heart disease interventional imaging. JACC Cardiovasc Imaging. 2018;11(12):1928–30. https://doi.org/10.1016/j.jcmg.2018.07.010.
• Hahn RT, Mahmood F, Kodali S, Lang R, Monaghan M, Gillam LD, et al. Core competencies in echocardiography for imaging structural heart disease interventions: an expert consensus statement. JACC Cardiovasc Imaging. 2019;12(12):2560–70. https://doi.org/10.1016/j.jcmg.2019.10.008This expert consensus document describes the new subspecialty of interventional echocardiography and outlines training requirements and minimum procedural volume for structural imagers.
Leipsic J, Norgaard BL, Khalique O, Cavalcante JL, Wang DD, Jilaihawi H, et al. Core competencies in cardiac CT for imaging structural heart disease interventions: an expert consensus statement. JACC Cardiovasc Imaging. 2019;12(12):2555–9. https://doi.org/10.1016/j.jcmg.2019.09.023.
Feldman T, Foster E, Glower DD, Kar S, Rinaldi MJ, Fail PS, et al. Percutaneous repair or surgery for mitral regurgitation. N Engl J Med. 2011;364(15):1395–406. https://doi.org/10.1056/NEJMoa1009355.
•• Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med. 2018;379(24):2307–18. https://doi.org/10.1056/NEJMoa1806640This landmark randomized trial demonstrated clinical benefit from the edge to edge transcatheter mitral repair to patients with 3–4+ functional mitral regurgitation, symptomatic despite guideline-directed medical therapy. The transcathter edge-to-edge repair was associated with reduced all-cause mortality, reduced heart failure hospitalizations, improved quality of life, and an excellent safety profile.
Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017;30(4):303–71. https://doi.org/10.1016/j.echo.2017.01.007.
Deferm S, Bertrand PB, Verbrugge FH, Verhaert D, Rega F, Thomas JD, et al. Atrial functional mitral regurgitation: JACC review topic of the week. J Am Coll Cardiol. 2019;73(19):2465–76. https://doi.org/10.1016/j.jacc.2019.02.061.
Carpentier A. Cardiac valve surgery—the “French correction”. J Thorac Cardiovasc Surg. 1983;86(3):323–37.
Hahn RT, Abraham T, Adams MS, Bruce CJ, Glas KE, Lang RM, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2013;26(9):921–64. https://doi.org/10.1016/j.echo.2013.07.009.
Grayburn PA, Weissman NJ, Zamorano JL. Quantitation of mitral regurgitation. Circulation. 2012;126(16):2005–17. https://doi.org/10.1161/CIRCULATIONAHA.112.121590.
Grayburn PA, Roberts WC. PAUL A. GRAYBURN, MD, on percutaneous mitral repair with the MitraClip device: a conversation with the editor. Am J Cardiol. 2011;108(2):277–84. https://doi.org/10.1016/j.amjcard.2011.04.003.
Asch FM, Grayburn PA, Siegel RJ, Kar S, Lim DS, Zaroff JG, et al. Echocardiographic outcomes after transcatheter leaflet approximation in patients with secondary mitral regurgitation: the COAPT trial. J Am Coll Cardiol. 2019;74(24):2969–79. https://doi.org/10.1016/j.jacc.2019.09.017.
Uretsky S, Gillam L, Lang R, Chaudhry FA, Argulian E, Supariwala A, et al. Discordance between echocardiography and MRI in the assessment of mitral regurgitation severity: a prospective multicenter trial. J Am Coll Cardiol. 2015;65(11):1078–88. https://doi.org/10.1016/j.jacc.2014.12.047.
Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(22):e57–185. https://doi.org/10.1016/j.jacc.2014.02.536.
Sorajja P, Kanda B, Bae R, Pedersen WA, Gossl M. Maneuvers for technical success with transcatheter mitral valve repair. Catheter Cardiovasc Interv. 2018;92(3):617–26. https://doi.org/10.1002/ccd.26899.
Rogers JH, Smith T. Repeat MitraClip procedures: in search of the perfect grasp. JACC Cardiovasc Interv. 2015;8(11):1490–2. https://doi.org/10.1016/j.jcin.2015.08.003.
Kreidel F, Frerker C, Schluter M, Alessandrini H, Thielsen T, Geidel S, et al. Repeat MitraClip therapy for significant recurrent mitral regurgitation in high surgical risk patients: impact of loss of leaflet insertion. JACC Cardiovasc Interv. 2015;8(11):1480–9. https://doi.org/10.1016/j.jcin.2015.06.019.
• Zoghbi WA, Asch FM, Bruce C, Gillam LD, Grayburn PA, Hahn RT, et al. Guidelines for the evaluation of valvular regurgitation after percutaneous valve repair or replacement: a report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Angiography and Interventions, Japanese Society of Echocardiography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2019;32(4):431–75. https://doi.org/10.1016/j.echo.2019.01.003This document describes current echocardiographic and multimodality imaging assessment of the residual regurgitation after transcatheter valve therapy. The guideline summarizes current evidence and expert consensus on how to assess residual regurgitation following transcathter valve procedure.
Avenatti E, Mackensen GB, El-Tallawi KC, Reisman M, Gruye L, Barker CM, et al. Diagnostic value of 3-dimensional vena contracta area for the quantification of residual mitral regurgitation after MitraClip procedure. JACC Cardiovasc Interv. 2019;12(6):582–91. https://doi.org/10.1016/j.jcin.2018.12.006.
Grayburn PA. The challenge of assessing residual mitral regurgitation during MitraClip procedures: is 3-dimensional vena contracta area the answer? JACC Cardiovasc Interv. 2019;12(6):592–4. https://doi.org/10.1016/j.jcin.2019.01.210.
Biaggi P, Felix C, Gruner C, Herzog BA, Hohlfeld S, Gaemperli O, et al. Assessment of mitral valve area during percutaneous mitral valve repair using the MitraClip system: comparison of different echocardiographic methods. Circ Cardiovasc Imaging. 2013;6(6):1032–40. https://doi.org/10.1161/CIRCIMAGING.113.000620.
Feldman T, Kar S, Elmariah S, Smart SC, Trento A, Siegel RJ, et al. Randomized comparison of percutaneous repair and surgery for mitral regurgitation: 5-year results of EVEREST II. J Am Coll Cardiol. 2015;66(25):2844–54. https://doi.org/10.1016/j.jacc.2015.10.018.
Maisano F, Franzen O, Baldus S, Schafer U, Hausleiter J, Butter C, et al. Percutaneous mitral valve interventions in the real world: early and 1-year results from the ACCESS-EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe. J Am Coll Cardiol. 2013;62(12):1052–61. https://doi.org/10.1016/j.jacc.2013.02.094.
Afzal S, Veulemans V, Piayda K, Schulz P, Horn P, Westenfeld R, et al. Real-time echocardiographic-fluoroscopic fusion imaging for transcatheter edge-to-edge mitral valve repair. J Am Soc Echocardiogr. 2020;33(5):635–6. https://doi.org/10.1016/j.echo.2020.01.018.
Maisano F, Taramasso M, Nickenig G, Hammerstingl C, Vahanian A, Messika-Zeitoun D, et al. Cardioband, a transcatheter surgical-like direct mitral valve annuloplasty system: early results of the feasibility trial. Eur Heart J. 2016;37(10):817–25. https://doi.org/10.1093/eurheartj/ehv603.
Lipiecki J, Siminiak T, Sievert H, Muller-Ehmsen J, Degen H, Wu JC, et al. Coronary sinus-based percutaneous annuloplasty as treatment for functional mitral regurgitation: the TITAN II trial. Open Heart. 2016;3(2):e000411. https://doi.org/10.1136/openhrt-2016-000411.
Witte KK, Lipiecki J, Siminiak T, Meredith IT, Malkin CJ, Goldberg SL, et al. The REDUCE FMR trial: a randomized sham-controlled study of percutaneous mitral annuloplasty in functional mitral regurgitation. JACC Heart Fail. 2019;7(11):945–55. https://doi.org/10.1016/j.jchf.2019.06.011.
Fiocco A, Nadali M, Speziali G, Colli A. Transcatheter mitral valve chordal repair: current indications and future perspectives. Front Cardiovasc Med. 2019;6:128. https://doi.org/10.3389/fcvm.2019.00128.
Geyer M, Sotiriou E, Tamm AR, Ruf TF, Kreidel F, Yang Y, et al. Advanced protocol for three-dimensional transesophageal echocardiography guidance implementing real-time multiplanar reconstruction for transcatheter mitral valve repair by direct annuloplasty. J Am Soc Echocardiogr. 2019;32(10):1359–65. https://doi.org/10.1016/j.echo.2019.05.015.
Little SH, Pirat B, Kumar R, Igo SR, McCulloch M, Hartley CJ, et al. Three-dimensional color Doppler echocardiography for direct measurement of vena contracta area in mitral regurgitation: in vitro validation and clinical experience. JACC Cardiovasc Imaging. 2008;1(6):695–704. https://doi.org/10.1016/j.jcmg.2008.05.014.
Shanks M, Siebelink HM, Delgado V, van de Veire NR, Ng AC, Sieders A, et al. Quantitative assessment of mitral regurgitation: comparison between three-dimensional transesophageal echocardiography and magnetic resonance imaging. Circ Cardiovasc Imaging. 2010;3(6):694–700. https://doi.org/10.1161/CIRCIMAGING.110.947176.
Marsan NA, Westenberg JJ, Ypenburg C, Delgado V, van Bommel RJ, Roes SD, et al. Quantification of functional mitral regurgitation by real-time 3D echocardiography: comparison with 3D velocity-encoded cardiac magnetic resonance. JACC Cardiovasc Imaging. 2009;2(11):1245–52. https://doi.org/10.1016/j.jcmg.2009.07.006.
Mak GJ, Blanke P, Ong K, Naoum C, Thompson CR, Webb JG, et al. Three-dimensional echocardiography compared with computed tomography to determine mitral annulus size before transcatheter mitral valve implantation. Circ Cardiovasc Imaging. 2016;9(6). https://doi.org/10.1161/CIRCIMAGING.115.004176.
Patzelt J, Seizer P, Zhang YY, Walker T, Schreieck J, Gawaz M, et al. Percutaneous mitral valve edge-to-edge repair with simultaneous biatrial intracardiac echocardiography: first-in-human experience. Circulation. 2016;133(15):1517–9. https://doi.org/10.1161/CIRCULATIONAHA.115.020923.
Basman C, Parmar YJ, Kronzon I. Intracardiac echocardiography for structural heart and electrophysiological interventions. Curr Cardiol Rep. 2017;19(10):102. https://doi.org/10.1007/s11886-017-0902-6.
Blanke P, Naoum C, Webb J, Dvir D, Hahn RT, Grayburn P, et al. Multimodality imaging in the context of transcatheter mitral valve replacement: establishing consensus among modalities and disciplines. JACC Cardiovasc Imaging. 2015;8(10):1191–208. https://doi.org/10.1016/j.jcmg.2015.08.004.
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Leo Marcoff serves as a member of a cardiovascular core laboratory that has contracts with Edwards Lifesciences and Medtronic, for which he receives no direct compensation.
Linda D. Gillam is the director of core laboratories with contracts with Edwards Lifesciences and Medtronic, for which she receives no direct compensation. She is also an advisor to Edwards Lifesciences.
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Marcoff, L., Gillam, L.D. Role of the Imager in Transcatheter Mitral Valve Repair. Curr Cardiol Rep 22, 120 (2020). https://doi.org/10.1007/s11886-020-01362-6
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DOI: https://doi.org/10.1007/s11886-020-01362-6