nine news mitral valve
Mitral valve prolapse is a common cause of a heart murmur caused by a "leaky" heart valve. “Given the mortality they’ve seen, it’s unlikely it’s going to be a good thing, but the reality is we just don’t know.”Responding to the concerns about the postprocedural gradient, Whisenant pointed to the gains seen in this cohort in terms of NYHA functional class and quality of life. Over six million Americans are living with heart failure and about half of them will die within five years of being diagnosed. The heart's weak and inefficient squeezing action cannot adequately circulate blood and can lead to multi-system organ failure. We would spend months making adjustments to optimize patients' medications before we could even look at whether they might be a candidate for the trial," explains Richardson.Transcatheter valve therapies have revolutionized the landscape of treatment options for patients with valvular heart disease.
“Are we putting patients at risk for early valve failure? It could be of potentially more concern. Mitral valve regurgitation — also called mitral regurgitation, mitral insufficiency or mitral incompetence — is a condition in which your heart's mitral valve doesn't close tightly, allowing blood to flow backward in your heart. If they were not a candidate for advanced heart failure therapy such as transplant or LVAD, they could face a long slow decline." However, the process of conducting the study was a slow endeavor and took more time to complete than other trials. “With some patients, I would still consider having repeat mitral valve surgery and then think about the option of putting in a mechanical device,” he said.If one were to opt for a MViV procedure, Dvir stressed, hemodynamic outcomes would have to be optimized, . The primary safety endpoint was procedural technical success, defined by the Mitral Valve Academic Research Consortium (MVARC) criteria upon exit from the hybrid suite—patient is alive with successful access, delivery, and retrieval of the delivery system; successful deployment and correct position of the first intended device; and freedom from emergency surgery or reintervention associated with the device or access procedure. What would be the rate of reintervention? In addition, he said, it’s possible that anticoagulation should be used in all patients to improve postprocedural hemodynamics; in this study, 80.8% of patients were discharged on oral anticoagulants.Asgar noted that the current study cannot answer questions about the long-term implications of having a postprocedural gradient of around 7 mm Hg. Of note, 30-day mortality was lower than expected based on STS score for both transseptal and transapical procedures. The outcomes were very impressive! Over six million Americans are living with heart failure and about half of them will die within five years of being diagnosed.Patients who experience MR against a background of existing heart failure are extremely ill because one condition exacerbates the other. “These are early signals of things we need to be prepared for and things we need to understand if we’re going to propose this procedure to a patient,” Asgar said.For the study, the investigators used data from the TVT Registry and the US Centers for Medicare & Medicaid Services.
Their quality of life declined and they tended to have more frequent hospitalizations for acute heart failure exacerbations. We anticipate that this data will support an expanded indication and much broader use of this less-invasive option.”Speaking with TCTMD, Anita Asgar, MD (Montreal Heart Institute, Canada), who wrote an accompanying commentary, said this is the largest collection of data available on MViV and is “a great first step [in] trying to understand the place of the technology.”Safety was acceptable for this population of high-risk patients, but there are some concerns, she said, pointing primarily to the hemodynamic result of the procedure. They returned to the United States on Jan. 9. Rare patients have unfavorable anatomy for mitral valve-in-valve, such as a high risk of LVOT obstruction, and may consider surgery depending on their surgical risk and the operator’s comfort with alcohol septal ablation and/or LAMPOON.”Asgar noted that if there is a patient who is at high surgical risk or has been refused for surgery, “your options are limited, and I think it’s important to advise patients that we do have a treatment that’s potentially available for them, and that is transcatheter mitral valve-in-valve as opposed to medical treatment, for which the outcomes will likely be poor.” But patients need to be adequately informed about what is known and MViV at this point and about the expected procedural results.Many patients with degenerated bioprosthetic valves also have tricuspid regurgitation, Asgar noted. Mitral valve regurgitation refers to extra blood flowing backward through the mitral valve and into the left atrium. Suzanne Richardson, MSN, RN, Clinical Program Manager for the Structural Heart and Valve Center at the Medical University of South Carolina (MUSC) explains, "In years past, if the patient was too high risk for surgery there was no other option and they entered a downward spiral leading to multi-organ dysfunction. This underscores the importance of the recent FDA approval of the MitraClip®for percutaneous therapy in heart failure patients with secondary MR. "It's an option for people who had no option before," says Richardson. “However, our results support transcatheter mitral valve-in-valve replacement as an option for most patients with failed surgical valves, independent of the patient's surgical risk.
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