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Current devices and interventions in mitral regurgitation

Aktuelle interventionelle Therapieverfahren der Mitralklappeninsuffizienz

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Abstract

Mitral regurgitation (MR) is the most common valvular disease. With a rising incidence in older age, the prevalence of relevant comorbidities inevitably increases. Considering the constantly aging population with high surgical risk, transcatheter therapy of MR is gaining increasing importance. Interventional therapy of either primary or secondary MR represents an alternative to pure drug or surgical therapy. With mitral valve transcatheter edge-to-edge repair, a well-established treatment has evolved in the past two decades. In addition, direct or indirect annuloplasty and ultimately transcatheter mitral valve implantation further expand the armamentarium. The current broad spectrum of interventional therapy options allows for patient-oriented therapy individually targeting different MR pathologies. This review discusses the current landscape of transcatheter therapies for relevant MR.

Zusammenfassung

Die Mitralklappeninsuffizienz (MI) stellt die häufigste Herzklappenerkrankung dar. Mit einer steigenden Inzidenz im Alter erhöht sich zwangsweise die Prävalenz relevanter Komorbiditäten. In Anbetracht des alternden Patientenkollektivs mit hohem perioperativem Risiko erlangt die interventionelle Versorgung der MI zunehmende Bedeutung. Die interventionelle Therapie der primären sowie sekundären MI stellt somit eine Alternative zur rein medikamentösen bzw. chirurgischen Therapie dar. Während sich in den letzten 2 Dekaden v. a. das Verfahren der Edge-to-Edge-Therapie etablierte, ermöglichen auch andere Therapieoptionen wie eine direkte oder indirekte Annuloplastie sowie nicht zuletzt der interventionelle Mitralklappenersatz eine individuelle Therapieoption. Das aktuell breite Spektrum an interventionellen Verfahren ermöglicht eine patientenorientierte Therapie, die individuell auf die unterschiedlichen Pathologien der MI abzielt. Die vorliegende Übersicht erörtert die aktuellen kathetergestützten Therapien zur Behandlung der relevanten MI.

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Abbreviations

COAPT:

Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation trial

CRT:

Cardiac resynchronization therapy

EPTFE:

Expanded polytetrafluoroethylene

EROA:

Effective regurgitant orifice area

ESC:

European Society of Cardiology

HF:

Heart failure

HFrEF:

Heart failure with reduced left ventricular ejection fraction

LA:

Left atrium

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

LVOT:

Left ventricular outflow tract

MITRA-FR:

Percutaneous Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation trial

MR:

Mitral regurgitation

M‑TEER:

Mitral valve transcatheter edge-to-edge repair

MV:

Mitral valve

NT-proBNP:

N‑terminal pro-B-type natriuretic peptide

NYHA:

New York Heart Association

PMR:

Primary (degenerative) mitral regurgitation

SMR:

Secondary (functional) mitral regurgitation

STS:

Society of Thoracic Surgeons

TMVI:

Transcatheter mitral valve implantation

References

  1. Verma S, Latter DA, Bonow RO (2021) Failed mitral TEER are there lessons for decision making? J Am Coll Cardiol. https://doi.org/10.1016/j.jacc.2021.04.086

    Article  PubMed  PubMed Central  Google Scholar 

  2. Nkomo VT, Gardin JM, Skelton TN et al (2006) Burden of valvular heart diseases: a population-based study. Lancet 368:1005–1011. https://doi.org/10.1016/s0140-6736(06)69208-8

    Article  PubMed  Google Scholar 

  3. Dziadzko V, Clavel M‑A, Dziadzko M et al (2018) Outcome and undertreatment of mitral regurgitation: a community cohort study. Lancet 391:960–969. https://doi.org/10.1016/s0140-6736(18)30473-2

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bonow RO, O’Gara PT (2017) Secondary mitral regurgitation and survival in patients with left ventricular dysfunction. JAMA Cardiol 2:1139. https://doi.org/10.1001/jamacardio.2017.3038

    Article  PubMed  Google Scholar 

  5. Asgar AW, Mack MJ, Stone GW (2015) Secondary mitral regurgitation in heart failure pathophysiology, prognosis, and therapeutic considerations. J Am Coll Cardiol 65:1231–1248. https://doi.org/10.1016/j.jacc.2015.02.009

    Article  PubMed  Google Scholar 

  6. Punnoose L, Burkhoff D, Cunningham L, Horn EM (2014) Functional mitral regurgitation: therapeutic strategies for a ventricular disease. J Card Fail 20:252–267. https://doi.org/10.1016/j.cardfail.2014.01.010

    Article  PubMed  Google Scholar 

  7. Baumgartner H, Falk V, Bax JJ et al (2017) 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 38:2739–2791. https://doi.org/10.1093/eurheartj/ehx391

    Article  PubMed  Google Scholar 

  8. Tabata N, Sugiura A, Tsujita K et al (2020) Percutaneous interventions for mitral and tricuspid heart valve diseases. Cardiovasc Interv Ther 35:62–71. https://doi.org/10.1007/s12928-019-00610-z

    Article  CAS  PubMed  Google Scholar 

  9. Otto CM, Nishimura RA, Bonow RO et al (2021) 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. Circulation 143:e72–e227. https://doi.org/10.1161/cir.0000000000000923

    Article  PubMed  Google Scholar 

  10. Abraham WT, Fisher WG, Smith AL et al (2002) Cardiac resynchronization in chronic heart failure. N Engl J Med 346:1845–1853. https://doi.org/10.1056/nejmoa013168

    Article  PubMed  Google Scholar 

  11. Stone GW, Lindenfeld J, Abraham WT et al (2018) Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med 379:2307–2318. https://doi.org/10.1056/nejmoa1806640

    Article  PubMed  Google Scholar 

  12. Mirabel M, Iung B, Baron G et al (2007) What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? Eur Heart J 28:1358–1365. https://doi.org/10.1093/eurheartj/ehm001

    Article  PubMed  Google Scholar 

  13. Baldus S, von Bardeleben RS, Eggebrecht H et al (2020) Interventionelle Therapie von AV-Klappenerkrankungen – Kriterien für die Zertifizierung von Mitralklappenzentren. Kardiologe 14:339–363. https://doi.org/10.1007/s12181-020-00409-w

    Article  Google Scholar 

  14. Demir OM, Bolland M, Curio J et al (2021) Transcatheter mitral valve replacement: current evidence and concepts. Interv Cardiol 16:e7. https://doi.org/10.15420/icr.2020.25

    Article  PubMed  PubMed Central  Google Scholar 

  15. Alfieri O, Maisano F, Bonis MD et al (2001) The double-orifice technique in mitral valve repair: a simple solution for complex problems. J Thorac Cardiovasc Surg 122:674–681. https://doi.org/10.1067/mtc.2001.117277

    Article  CAS  PubMed  Google Scholar 

  16. Feldman T, Kar S, Elmariah S et al (2015) Randomized comparison of percutaneous repair and surgery for mitral regurgitation 5‑year results of EVEREST II. J Am Coll Cardiol 66:2844–2854. https://doi.org/10.1016/j.jacc.2015.10.018

    Article  PubMed  Google Scholar 

  17. Feldman T, Foster E, Glower DD et al (2011) Percutaneous repair or surgery for mitral regurgitation. N Engl J Med 364:1395–1406. https://doi.org/10.1056/nejmoa1009355

    Article  CAS  PubMed  Google Scholar 

  18. Lim DS, Reynolds MR, Feldman T et al (2014) Improved functional status and quality of life in prohibitive surgical risk patients with degenerative mitral regurgitation after transcatheter mitral valve repair. J Am Coll Cardiol 64:182–192. https://doi.org/10.1016/j.jacc.2013.10.021

    Article  PubMed  Google Scholar 

  19. Ailawadi G, Lim DS, Mack MJ et al (2019) One-year outcomes after mitraclip for functional mitral regurgitation. Circulation 139:37–47. https://doi.org/10.1161/circulationaha.117.031733

    Article  PubMed  Google Scholar 

  20. Szerlip M, Spargias KS, Makkar R et al (2021) 2‑year outcomes for transcatheter repair in patients with mitral regurgitation from the CLASP study. Jacc Cardiovasc Interv. https://doi.org/10.1016/j.jcin.2021.04.001

    Article  PubMed  Google Scholar 

  21. Stone GW, Vahanian AS, Adams DH et al (2015) Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: part 1: clinical trial design principles: a consensus document from the mitral valve academic research consortium. J Am Coll Cardiol 66:278–307. https://doi.org/10.1016/j.jacc.2015.05.046

    Article  PubMed  Google Scholar 

  22. Coats AJS, Anker SD, Baumbach A et al (2021) The management of secondary mitral regurgitation in patients with heart failure: a joint position statement from the heart failure association (HFA), European association of cardiovascular imaging (EACVI), European heart rhythm association (EHRA), and European association of percutaneous cardiovascular interventions (EAPCI) of the ESC. Eur Heart J 42:1254–1269. https://doi.org/10.1093/eurheartj/ehab086

    Article  PubMed Central  Google Scholar 

  23. Adamo M, Godino C, Giannini C et al (2019) Left ventricular reverse remodelling predicts long-term outcomes in patients with functional mitral regurgitation undergoing MitraClip therapy: results from a multicentre registry. Eur J Heart Fail 21:196–204. https://doi.org/10.1002/ejhf.1343

    Article  PubMed  Google Scholar 

  24. Geis NA, Puls M, Lubos E et al (2018) Safety and efficacy of MitraClipTM therapy in patients with severely impaired left ventricular ejection fraction: results from the German transcatheter mitral valve interventions (TRAMI) registry. Eur J Heart Fail 20:598–608. https://doi.org/10.1002/ejhf.910

    Article  PubMed  Google Scholar 

  25. Neuss M, Schau T, Schoepp M et al (2013) Patient selection criteria and midterm clinical outcome for MitraClip therapy in patients with severe mitral regurgitation and severe congestive heart failure. Eur J Heart Fail 15:786–795. https://doi.org/10.1093/eurjhf/hfs214

    Article  PubMed  Google Scholar 

  26. Swaans MJ, Bakker ALM, Alipour A et al (2014) Survival of transcatheter mitral valve repair compared with surgical and conservative treatment in high-surgical-risk patients. Jacc Cardiovasc Interv 7:875–881. https://doi.org/10.1016/j.jcin.2014.01.171

    Article  PubMed  Google Scholar 

  27. Velazquez EJ, Samad Z, Al-Khalidi HR et al (2015) The MitraClip and survival in patients with mitral regurgitation at high risk for surgery: a propensity-matched comparison. Am Heart J 170:1050–1059.e3. https://doi.org/10.1016/j.ahj.2015.08.004

    Article  PubMed  Google Scholar 

  28. Giannini C, Fiorelli F, Carlo MD et al (2016) Comparison of percutaneous mitral valve repair versus conservative treatment in severe functional mitral regurgitation. Am J Cardiol 117:271–277. https://doi.org/10.1016/j.amjcard.2015.10.044

    Article  PubMed  Google Scholar 

  29. Nickenig G, Estevez-Loureiro R, Franzen O et al (2014) Percutaneous mitral valve edge-to-edge repair in-hospital results and 1‑year follow-up of 628 patients of the 2011–2012 pilot European sentinel registry. J Am Coll Cardiol 64:875–884. https://doi.org/10.1016/j.jacc.2014.06.1166

    Article  PubMed  Google Scholar 

  30. Keßler M, Seeger J, Muche R et al (2019) Predictors of rehospitalization after percutaneous edge-to-edge mitral valve repair by MitraClip implantation. Eur J Heart Fail 21:182–192. https://doi.org/10.1002/ejhf.1289

    Article  CAS  PubMed  Google Scholar 

  31. Puls M, Lubos E, Boekstegers P et al (2016) One-year outcomes and predictors of mortality after MitraClip therapy in contemporary clinical practice: results from the German transcatheter mitral valve interventions registry. Eur Heart J 37:703–712. https://doi.org/10.1093/eurheartj/ehv627

    Article  PubMed  Google Scholar 

  32. Obadia J‑F, Messika-Zeitoun D, Leurent G et al (2018) Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med 379:2297–2306. https://doi.org/10.1056/nejmoa1805374

    Article  PubMed  Google Scholar 

  33. Iung B, Armoiry X, Vahanian A et al (2019) Percutaneous repair or medical treatment for secondary mitral regurgitation: outcomes at 2 years. Eur J Heart Fail 21:1619–1627. https://doi.org/10.1002/ejhf.1616

    Article  PubMed  Google Scholar 

  34. Messika-Zeitoun D, Nickenig G, Latib A et al (2018) Transcatheter mitral valve repair for functional mitral regurgitation using the cardioband system: 1 year outcomes. Eur Heart J 40:466–472. https://doi.org/10.1093/eurheartj/ehy424

    Article  Google Scholar 

  35. Miller M, Thourani VH, Whisenant B (2018) The cardioband transcatheter annular reduction system. Ann Cardiothorac Surg 7:741–747. https://doi.org/10.21037/acs.2018.10.10

    Article  PubMed  PubMed Central  Google Scholar 

  36. Patterson T, Adams H, Allen C et al (2019) Indirect annuloplasty to treat functional mitral regurgitation: current results and future perspectives. Front Cardiovasc Med 6:60. https://doi.org/10.3389/fcvm.2019.00060

    Article  PubMed  PubMed Central  Google Scholar 

  37. Witte KK, Lipiecki J, Siminiak T et al (2019) The REDUCE FMR trial: a randomized sham-controlled study of percutaneous mitral annuloplasty in functional mitral regurgitation. JACC Heart Fail 7:945–955. https://doi.org/10.1016/j.jchf.2019.06.011

    Article  PubMed  Google Scholar 

  38. Maniu CV, Patel JB, Reuter DG et al (2004) Acute and chronic reduction of functional mitral regurgitation in experimental heart failure by percutaneous mitral annuloplasty. J Am Coll Cardiol 44:1652–1661. https://doi.org/10.1016/j.jacc.2004.03.085

    Article  PubMed  Google Scholar 

  39. Colli A, Manzan E, Aidietis A et al (2018) An early European experience with transapical off-pump mitral valve repair with NeoChord implantation. Eur J Cardiothorac Surg 54:460–466. https://doi.org/10.1093/ejcts/ezy064

    Article  PubMed  Google Scholar 

  40. Gammie JS, Bartus K, Gackowski A et al (2018) Beating-heart mitral valve repair using a novel ePTFE cordal implantation device: a prospective trial. J Am Coll Cardiol 71:25–36. https://doi.org/10.1016/j.jacc.2017.10.062

    Article  PubMed  Google Scholar 

  41. Sorajja P, Moat N, Badhwar V et al (2019) Initial feasibility study of a new transcatheter mitral prosthesis the first 100 patients. J Am Coll Cardiol 73:1250–1260. https://doi.org/10.1016/j.jacc.2018.12.066

    Article  PubMed  Google Scholar 

  42. Blanke P, Naoum C, Dvir D et al (2017) Predicting LVOT obstruction in transcatheter mitral valve implantation concept of the Neo-LVOT. JACC Cardiovasc Imaging 10:482–485. https://doi.org/10.1016/j.jcmg.2016.01.005

    Article  PubMed  Google Scholar 

  43. Feldman T, Kar S, Rinaldi M et al (2009) Percutaneous mitral repair with the MitraClip system safety and midterm durability in the initial EVEREST (endovascular valve edge-to-edge REpair study) cohort. J Am Coll Cardiol 54:686–694. https://doi.org/10.1016/j.jacc.2009.03.077

    Article  PubMed  Google Scholar 

  44. Lim DS, Kar S, Spargias K et al (2019) Transcatheter valve repair for patients with mitral regurgitation 30-day results of the CLASP study. Jacc Cardiovasc Interv 12:1369–1378. https://doi.org/10.1016/j.jcin.2019.04.034

    Article  PubMed  Google Scholar 

  45. Nickenig G, Hammerstingl C, Schueler R et al (2016) Transcatheter mitral annuloplasty in chronic functional mitral regurgitation 6‑month results with the cardioband percutaneous mitral repair system. JACC Cardiovasc Interv 9:2039–2047. https://doi.org/10.1016/j.jcin.2016.07.005

    Article  PubMed  Google Scholar 

  46. Nickenig G, Schueler R, Dager A et al (2016) Treatment of chronic functional mitral valve regurgitation with a percutaneous annuloplasty system. J Am Coll Cardiol 67:2927–2936. https://doi.org/10.1016/j.jacc.2016.03.591

    Article  PubMed  Google Scholar 

  47. Beller JP, Rogers JH, Thourani VH, Ailawadi G (2018) Early clinical results with the tendyne transcatheter mitral valve replacement system. Ann Cardiothorac Surg 7:776–779. https://doi.org/10.21037/acs.2018.10.01

    Article  PubMed  PubMed Central  Google Scholar 

  48. Cheung A (2018) Early experience of TIARA transcatheter mitral valve replacement system. Ann Cardiothorac Surg 7:787–791. https://doi.org/10.21037/acs.2018.09.05

    Article  PubMed  PubMed Central  Google Scholar 

  49. Ferreira-Neto AN, Dagenais F, Bernier M et al (2018) Transcatheter mitral valve replacement with a new supra-annular valve first-in-human experience with the altavalve system. JACC Cardiovasc Interv 12:208–209. https://doi.org/10.1016/j.jcin.2018.10.056

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany

    Benedikt Koell MD, Daniel Kalbacher MD &  Edith Lubos MD

  2. German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, DZHK, Hamburg, Germany

    Benedikt Koell MD, Daniel Kalbacher MD &  Edith Lubos MD

  3. University Heart & Vascular Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany

    Edith Lubos MD

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Correspondence to Edith Lubos MD.

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Conflict of interest

E. Lubos (EL) and D. Kalbacher (DK) received speaker honoraria and travel expenses from Abbott and Edwards LifeSciences, research grants (EL) from Abbott, proctor fees (DK) from Edwards LifeSciences, and honoraria for advisory board activities (EL) from Cardiovalve. B. Koell declares that he has no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Koell, B., Kalbacher, D. & Lubos, E. Current devices and interventions in mitral regurgitation. Herz 46, 419–428 (2021). https://doi.org/10.1007/s00059-021-05055-w

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