Dan Haberman1, Rodrigo Estévez-Loureiro2, Tomas Benito-Gonzalez3, Paolo Denti4, Dabit Arzamendi5, Marianna Adamo6, Xavier Freixa7, Luis Nombela-Franco8, Pedro Villablanca9, Lian Krivoshei10, Neil Fam11, Konstantinos Spargias12, Andrew Czarnecki13, Isaac Pascual14, Fabien Praz15, Doron Sudarsky16, Arthur Kerner17, Vlasis Ninios18, Marco Gennari19,20, Ronen Beeri21, Leor Perl22, Yishay Wasserstrum23, Haim Danenberg21, Lion Poles1, Jacob George1, Berenice Caneiro-Queija2, Salvatore Scianna20, Igal Moaraf24, Davide Schiavi4, Claudia Scardino25, Noé Corpataux15, Julio Echarte-Morales3, Michael Chrissoheris12, Estefanía Fernández-Peregrina5, Mattia Di Pasquale6, Ander Regueiro7, Carlos Vergara-Uzcategui8, Andres Iñiguez-Romo2, Felipe Fernández-Vázquez3, Danny Dvir26, Francesco Maisano4, Maurizio Taramasso20, Mony Shuvy21,26. 1. Heart Center, Kaplan Medical Center, 1, Pasternak Street, Rehovot 7661041, Israel. Affiliated to the Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel. 2. Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo 36213, Spain. 3. Department of Cardiology, University Hospital of León, C/ ALTOS DE NAVA, S/N, León 24071, Spain. 4. Cardiochirurgia IRCCS Ospedale San Raffaele, Via Olgettina, 60, Milano 20132, Italy. 5. Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu, Carrer de Sant Quintí, 89, Barcelona 08041, Spain. 6. Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Piazzale Spedali Civili, 1, Brescia 25123, Italy. 7. Interventional Cardiology Unit, Hospital Clinic, C.de Villarroel, 170, Barcelona, Spain. 8. Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria San Carlos, IdISSC, Calle del Prof Martín Lagos, s/n, Madrid 28040, Spain. 9. Interventional Cardiology, The Center for Structural Heart Disease, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI, USA. 10. Department of cardiology, Kantonsspital Liestal, Rheinstrasse 26, 4410 Liestal, Switzerland. 11. Division of Cardiology, St. Michael's Hospital, University of Toronto, 36 Queen St E, Toronto, ON M5B 1W8, Canada. 12. Department of Transcatheter Heart Valves, HYGEIA Hospital, Erithrou Stavrou 4, Marousi 151 23, Athens, Greece. 13. Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Hospital Road, ON M4N 3M5, Canada. 14. Department of Cardiology, Hospital Universitario Central de Asturias, Av. Roma, Oviedo 33011, Spain. 15. Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland. 16. Cardiovascular Institute, Baruch Padeh Medical Center, Poriya, Dov Hoz 0, Tiberias, Israel. 17. Department of Cardiology, Rambam Medical Center, and B. Rappaport Faculty of Medicine, Technion Medical School, Efron St 1, Haifa 35254, Israel. 18. Department of Cardiology, Interbalkan European Medical Center, Asklipiou 10, Pilea, Thessaloniki 55535, Greece. 19. IRCCS Centro Cardiologico Monzino, Department of Cardiovascular Surgery, Via Carlo Parea, 4, Milan 20138, Italy. 20. HerzZentrum Hirslanden Zürich, Witellikerstrasse 36, Zurich 8008, Switzerland. 21. Heart Institute, Hadassah-Hebrew University Medical Center, Kalman Ya'akov Man St, Jerusalem 9755506, Israel. 22. Cardiology Department, Rabin Medical Center and The 'Sackler' Faculty of Medicine, Tel Aviv University, Zeev Jabotinsky St 39 Petah Tikva, 49100, Israel. 23. Leviev Heart Center, Sheba Medical Center & Sackler School of Medicine, Tel Aviv University, Derech Sheba 2, Ramat Gan, Tel Aviv, Israel. 24. Kantonsspital Baden, Department of Cardiology, Im Ergel 1, 5404 Baden, Switzerland. 25. Department of Cardiology, Joan XXIII University Hospital, C/ Dr. Mallafrè Guasch, 4, Tarragona 43005, Spain. 26. Jesselson Integrated Heart Centre, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, 12, Shmu'el Bait, POB 3235, Jerusalem 9103102, Israel.
Abstract
AIMS: Severe mitral regurgitation (MR) following acute myocardial infarction (MI) is associated with high mortality rates and has inconclusive recommendations in clinical guidelines. We aimed to report the international experience of patients with secondary MR following acute MI and compare the outcomes of those treated conservatively, surgically, and percutaneously. METHODS AND RESULTS: Retrospective international registry of consecutive patients with at least moderate-to-severe MR following MI treated in 21 centres in North America, Europe, and the Middle East. The registry included patients treated conservatively and those having surgical mitral valve repair or replacement (SMVR) or percutaneous mitral valve repair (PMVR) using edge-to-edge repair. The primary endpoint was in-hospital mortality. A total of 471 patients were included (43% female, age 73 ± 11 years): 205 underwent interventions, of whom 106 were SMVR and 99 PMVR. Patients who underwent mitral valve intervention were in a worse clinical state (Killip class ≥3 in 60% vs. 43%, P < 0.01), but yet had lower in-hospital and 1-year mortality compared with those treated conservatively [11% vs. 27%, P < 0.01 and 16% vs. 35%, P < 0.01; adjusted hazard ratio (HR) 0.28, 95% confidence interval (CI) 0.18-0.46, P < 0.01]. Surgical mitral valve repair or replacement was performed earlier than PMVR [median of 12 days from MI date (interquartile range 5-19) vs. 19 days (10-40), P < 0.01]. The immediate procedural success did not differ between SMVR and PMVR (92% vs. 93%, P = 0.53). However, in-hospital and 1-year mortality rates were significantly higher in SMVR than in PMVR (16% vs. 6%, P = 0.03 and 31% vs. 17%, P = 0.04; adjusted HR 3.75, 95% CI 1.55-9.07, P < 0.01). CONCLUSIONS: Early intervention may mitigate the poor prognosis associated with conservative therapy in patients with post-MI MR. Percutaneous mitral valve repair can serve as an alternative for surgery in reducing MR for high-risk patients. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Severe mitral regurgitation (MR) following acute myocardial infarction (MI) is associated with high mortality rates and has inconclusive recommendations in clinical guidelines. We aimed to report the international experience of patients with secondary MR following acute MI and compare the outcomes of those treated conservatively, surgically, and percutaneously. METHODS AND RESULTS: Retrospective international registry of consecutive patients with at least moderate-to-severe MR following MI treated in 21 centres in North America, Europe, and the Middle East. The registry included patients treated conservatively and those having surgical mitral valve repair or replacement (SMVR) or percutaneous mitral valve repair (PMVR) using edge-to-edge repair. The primary endpoint was in-hospital mortality. A total of 471 patients were included (43% female, age 73 ± 11 years): 205 underwent interventions, of whom 106 were SMVR and 99 PMVR. Patients who underwent mitral valve intervention were in a worse clinical state (Killip class ≥3 in 60% vs. 43%, P < 0.01), but yet had lower in-hospital and 1-year mortality compared with those treated conservatively [11% vs. 27%, P < 0.01 and 16% vs. 35%, P < 0.01; adjusted hazard ratio (HR) 0.28, 95% confidence interval (CI) 0.18-0.46, P < 0.01]. Surgical mitral valve repair or replacement was performed earlier than PMVR [median of 12 days from MI date (interquartile range 5-19) vs. 19 days (10-40), P < 0.01]. The immediate procedural success did not differ between SMVR and PMVR (92% vs. 93%, P = 0.53). However, in-hospital and 1-year mortality rates were significantly higher in SMVR than in PMVR (16% vs. 6%, P = 0.03 and 31% vs. 17%, P = 0.04; adjusted HR 3.75, 95% CI 1.55-9.07, P < 0.01). CONCLUSIONS: Early intervention may mitigate the poor prognosis associated with conservative therapy in patients with post-MI MR. Percutaneous mitral valve repair can serve as an alternative for surgery in reducing MR for high-risk patients. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Leor Perl; Tamir Bental; Katia Orvin; Hana Vaknin-Assa; Gabriel Greenberg; Pablo Codner; Yaron Shapira; Mordehay Vaturi; Alexander Sagie; Ran Kornowski Journal: Front Cardiovasc Med Date: 2022-01-13
Authors: Rodrigo Estévez-Loureiro; Marta Tavares Da Silva; José Antonio Baz-Alonso; Berenice Caneiro-Queija; Manuel Barreiro-Pérez; Francisco Calvo-Iglesias; Rocio González-Ferreiro; Luis Puga; Miguel Piñón; Andrés Íñiguez-Romo Journal: Front Cardiovasc Med Date: 2022-09-23