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Percutaneous Mitral Valve Repair for Functional Mitral Regurgitation: MitraClip
S114 Journal of Cardiac Failure Vol. 19 No. 10S October 2013
Symposium 2 S2-1 Effect of Adaptive Servo-ventilation on Functional Mitral Regurgitation in Patients with Chronic Heart Failure MASARU ARAKI Second Department of Internal Medicine, University of Occupational and Environmental Health Background: Although adaptive servo-ventilation (ASV) has a beneficial impact on patients with chronic heart failure (CHF), little is known about its effects on the functional mitral regurgitation (FMR) of CHF patients. The aim of our present study was to test the hypothesis that ASV would improve the severity of FMR. Methods: Echocardiographic parameters were measured in 30 CHF patients with FMR who initiated ASV therapy and underwent follow-up echocardiography after six months of ASV. Patients were divided into two groups; an ASV group (n520) and a withdrawal group (n510). Results: In the follow-up study, a significant reduction of the left ventricular (LV) and left atrial (LA) volumes, and improved systolic (LV ejection fraction) and diastolic function (E/e’) parameters were observed in the ASV group. The severity of FMR (vena contracta width), tenting area and mitral annular area were also improved. These beneficial effects were not observed in the withdrawal group. There were significant correlations between the changes in the severity of FMR and the LV end-diastolic volume, end-systolic volume and LA volume. Conclusion: We have found a significant reduction in the severity of FMR in CHF patients treated with ASV therapy. Our data suggest that chronic ASV therapy produces LV and LA reverse remodeling, resulting in an improvement in LV function and the severity of FMR in patients with CHF.
S2-2 Effect of Waon therapy on functional mitral valve regurgitation TOSHINORI YUASA1, HIDETO CYAEN1, YOSHIHISA HORIZOE1, NAMI UEYA1, KAYOKO TANAKA1, NAOKO KITAMURA2, KUNITSUGU TAKASAKI1, MASAAKI MIYATA1, AKIRA KISANUKI3, MITSURU OISHI1 1 Department of Cardiovascular and Hypertension, Kagoshima University Faculty of Medicine, 2Department of Clinical Laboratory, Kagoshima University Hospital, 3 Department of Health Science, Kagoshima University Faculty of Medicine
LVDs was 4869, MR grade was 2.361.0. In IMR cases, PMS was perfomed in 23 patients (19%) and LVP in 24 (20). PMS was performed in patients with symmetric leaflet tethering owing to Papillary muscle displacement. LVP was perfomed in patients with a markedly dilated ventricle, clear demarcation between scarred and normal tissue. Results: The five-year survival was 59%, the five-year MACCE (major adverse cardiac and cerebral event) free was 61%. The five-year MR moderate free was 85. The five-year survival rate and MACCE free was significantly same in patients regardless perfomed LVP. MR moderate free rate is same in patients regardless PMS. The five-year MACCE free in patients with ischemic dilated cardiomyopathy in LVP group and in no LVPgroup was 22% and 67% (loglank P50.007). Conclusion: PMS and LVP perfomed IMR of the severe form. Although control of MR grade was enable appropriately by examing indication closely, and adding such a operation, it depends on remaining left ventricle function to long term results.
S2-5 Impact of Papillary Muscle Relocation in the Surgical Repair for Functional Mitral Regurgitation TAIJU WATANABE, TOMOHIRO MIZUNO, KEIJI OI, SUSUMU MANABE, TSUYOSHI HACHIMARU, HIDEHITO KUROKI, TATSUKI FUJIWARA, HIROKUNI ARAI Department of Cardiovascular Surgery, Tokyo Medical and Dental University Objective: In severe functional mitral regurgitation (FMR) cases, we have added papillary muscle relocation (PMR) to restrictive mitral annuloplasty (RMAP) to avoid MR recurrence. Methods: 39 patients were examined by pre- and post-operative transthoracic echocardiography. In limited tethering cases, RMAP alone was performed (Group N: n523). In severe tethering cases, PMR in the direction of posterior annulus (Group P: n510) or anterior annulus (Group A: n56) was performed. We devised new indicator; Mitral Inflow Angle (MIA) to assess the diastolic mitral valve function. Result: Each procedure was effective to reduce MR after surgery. However, MIAwas significantly reduced in Group N and Group P, and preserved in Group A. Conclusion: Papillary muscle should be relocated in the direction of anterior annulus to preserve diastolic mitral valve function.
It has been reported that Waon therapy improves cardiac and vasucular function in patient with chronic heart failure using a far infrared-ray dry sauna bath of 60 degrees Celsius. The acute effect of Waon therapy is brought by peripheral artery expansion and increasing cardiac output. Furthermore, the reduction of the preload with the expansion of pulmonary and systematic vein brings the decrease in mitral regurgitation (MR) and pulmonary capillary wedge pressure. In addition, chronic effect of Waon therapy is the improvement in cardiac function, hemodynamics, vascular function and the neurohumor-related factors. On the other hand, the functional MR is caused by tethering of the mitral valve with the displacement of the papillary muscle, and decrease of mitral closing force. Waon therapy achieves the improvement in morphologies around mitral valve indicating reduced tethering of mitral valve. I also want to show the mechanisms of improvement in MR by Waon therapy.
S2-3 Percutaneous Mitral Valve Repair for Functional Mitral Regurgitation: MitraClip NORIO TADA Cardiology, Sendai Kousei Hospital MitraClip is a percutaneous treatment of mitral valve regurgitation (MR) with edge-toedge repair based on surgical Alfieri technique concept. This is a less invasive therapy without a need of open-heart surgery and cardiopulmonary pump. Clinical trial data have shown feasibility and safety for high surgical risk patients due to degenerative or to functional MR. Furthermore some papers have shown that MitraClip reduces functional MR with very low EF patients or CRT non-responders and promotes their clinical benefits. MitraClip is expected to be an alternative therapeutic option for heart failure with functional MR and early introduction to Japan is warranted.
S2-4 Papillary Muscle Surgery and Left Ventiriculoplasty for Ischemic Mitral Valve Regurgitation DAISUKE FUTAGAMI, TATSUHIKO KOMIYA Cardiovascular Surgery, Kurashiki Central Hospital Objective: To present results of our mitral valve surgery for patients with ischemic mitral valve regurgitation(IMR) and evaluated the safety and efficacy of Papillary Muscle Surgery(PMS) and Left Ventriculoplasty(LVP) in patients with IMR. Method: The subjects were 122 patients with IMR who underwent operation from 2000 to 2012. The mean age was 69610. Preoperative LVEF was 34611, LVDd was 5968,
S2-6 Complete Papillary Muscle Approximation is Associated with High Durability of Mitral Valve Repair for Ischemic Mitral Regurgitation SATORU WAKASA, YASUSHIGE SHINGU, TOMONORI OOKA, TSUYOSHI TACHIBANA, YOSHIRO MATSUI Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine Objective: Reduction annuloplasty alone for ischemic mitral regurgitation (MR) cannot prevent late recurrence of MR, which relates to mortality. Surgical approach to this etiology is still controversial. Methods and Results: We studied 45 patients who underwent mitral annuloplasty and papillary muscle approximation (PMA) for ischemic MR between 2003 and 2012. Papillary muscles were approximated entirely (cPMA: complete PMA, n532) through a left ventricular (LV) incision or at the tip (iPMA: incomplete PMA, n513) through the cardiac valves. Twenty-three patients with cPMA also underwent LV plasty (LVP). The baseline MR grade, NYHA class, LV end-diastolic diameter, and LV ejection fraction (LVEF) were 2.861.0, 3.260.6, 6766 mm, and 30610%, respectively. There were no differences in those parameters among those with iPMA, cPMA/LVP-, and cPMA/LVP+, though iPMA patients had better LVEF than others. Three patients died before discharge and 12 died during the follow-up. Recurrence of grade 2+ and 3+ MR occurred in 8 and 2 patients, respectively. Recurrence of MR $2+ was associated with mortality (log-rank P50.022). The 4-year freedom rates from recurrence of MR $2+ were 85%, 75%, and 48% for those with cPMA/LVP+, cPMA/LVP-, and iPMA, respectively (log-rank P50.019), though the freedom rates did not differ between those with cPMA/LVP+ and cPMA/LVP- (log-rank P50.98). Conclusions: Complete PMA could be associated with high durability of mitral valve repair for ischemic MR.
Symposium 2 S2-1 Effect of Adaptive Servo-ventilation on Functional Mitral Regurgitation in Patients with Chronic Heart Failure MASARU ARAKI Second Department of Internal Medicine, University of Occupational and Environmental Health Background: Although adaptive servo-ventilation (ASV) has a beneficial impact on patients with chronic heart failure (CHF), little is known about its effects on the functional mitral regurgitation (FMR) of CHF patients. The aim of our present study was to test the hypothesis that ASV would improve the severity of FMR. Methods: Echocardiographic parameters were measured in 30 CHF patients with FMR who initiated ASV therapy and underwent follow-up echocardiography after six months of ASV. Patients were divided into two groups; an ASV group (n520) and a withdrawal group (n510). Results: In the follow-up study, a significant reduction of the left ventricular (LV) and left atrial (LA) volumes, and improved systolic (LV ejection fraction) and diastolic function (E/e’) parameters were observed in the ASV group. The severity of FMR (vena contracta width), tenting area and mitral annular area were also improved. These beneficial effects were not observed in the withdrawal group. There were significant correlations between the changes in the severity of FMR and the LV end-diastolic volume, end-systolic volume and LA volume. Conclusion: We have found a significant reduction in the severity of FMR in CHF patients treated with ASV therapy. Our data suggest that chronic ASV therapy produces LV and LA reverse remodeling, resulting in an improvement in LV function and the severity of FMR in patients with CHF.
S2-2 Effect of Waon therapy on functional mitral valve regurgitation TOSHINORI YUASA1, HIDETO CYAEN1, YOSHIHISA HORIZOE1, NAMI UEYA1, KAYOKO TANAKA1, NAOKO KITAMURA2, KUNITSUGU TAKASAKI1, MASAAKI MIYATA1, AKIRA KISANUKI3, MITSURU OISHI1 1 Department of Cardiovascular and Hypertension, Kagoshima University Faculty of Medicine, 2Department of Clinical Laboratory, Kagoshima University Hospital, 3 Department of Health Science, Kagoshima University Faculty of Medicine
LVDs was 4869, MR grade was 2.361.0. In IMR cases, PMS was perfomed in 23 patients (19%) and LVP in 24 (20). PMS was performed in patients with symmetric leaflet tethering owing to Papillary muscle displacement. LVP was perfomed in patients with a markedly dilated ventricle, clear demarcation between scarred and normal tissue. Results: The five-year survival was 59%, the five-year MACCE (major adverse cardiac and cerebral event) free was 61%. The five-year MR moderate free was 85. The five-year survival rate and MACCE free was significantly same in patients regardless perfomed LVP. MR moderate free rate is same in patients regardless PMS. The five-year MACCE free in patients with ischemic dilated cardiomyopathy in LVP group and in no LVPgroup was 22% and 67% (loglank P50.007). Conclusion: PMS and LVP perfomed IMR of the severe form. Although control of MR grade was enable appropriately by examing indication closely, and adding such a operation, it depends on remaining left ventricle function to long term results.
S2-5 Impact of Papillary Muscle Relocation in the Surgical Repair for Functional Mitral Regurgitation TAIJU WATANABE, TOMOHIRO MIZUNO, KEIJI OI, SUSUMU MANABE, TSUYOSHI HACHIMARU, HIDEHITO KUROKI, TATSUKI FUJIWARA, HIROKUNI ARAI Department of Cardiovascular Surgery, Tokyo Medical and Dental University Objective: In severe functional mitral regurgitation (FMR) cases, we have added papillary muscle relocation (PMR) to restrictive mitral annuloplasty (RMAP) to avoid MR recurrence. Methods: 39 patients were examined by pre- and post-operative transthoracic echocardiography. In limited tethering cases, RMAP alone was performed (Group N: n523). In severe tethering cases, PMR in the direction of posterior annulus (Group P: n510) or anterior annulus (Group A: n56) was performed. We devised new indicator; Mitral Inflow Angle (MIA) to assess the diastolic mitral valve function. Result: Each procedure was effective to reduce MR after surgery. However, MIAwas significantly reduced in Group N and Group P, and preserved in Group A. Conclusion: Papillary muscle should be relocated in the direction of anterior annulus to preserve diastolic mitral valve function.
It has been reported that Waon therapy improves cardiac and vasucular function in patient with chronic heart failure using a far infrared-ray dry sauna bath of 60 degrees Celsius. The acute effect of Waon therapy is brought by peripheral artery expansion and increasing cardiac output. Furthermore, the reduction of the preload with the expansion of pulmonary and systematic vein brings the decrease in mitral regurgitation (MR) and pulmonary capillary wedge pressure. In addition, chronic effect of Waon therapy is the improvement in cardiac function, hemodynamics, vascular function and the neurohumor-related factors. On the other hand, the functional MR is caused by tethering of the mitral valve with the displacement of the papillary muscle, and decrease of mitral closing force. Waon therapy achieves the improvement in morphologies around mitral valve indicating reduced tethering of mitral valve. I also want to show the mechanisms of improvement in MR by Waon therapy.
S2-3 Percutaneous Mitral Valve Repair for Functional Mitral Regurgitation: MitraClip NORIO TADA Cardiology, Sendai Kousei Hospital MitraClip is a percutaneous treatment of mitral valve regurgitation (MR) with edge-toedge repair based on surgical Alfieri technique concept. This is a less invasive therapy without a need of open-heart surgery and cardiopulmonary pump. Clinical trial data have shown feasibility and safety for high surgical risk patients due to degenerative or to functional MR. Furthermore some papers have shown that MitraClip reduces functional MR with very low EF patients or CRT non-responders and promotes their clinical benefits. MitraClip is expected to be an alternative therapeutic option for heart failure with functional MR and early introduction to Japan is warranted.
S2-4 Papillary Muscle Surgery and Left Ventiriculoplasty for Ischemic Mitral Valve Regurgitation DAISUKE FUTAGAMI, TATSUHIKO KOMIYA Cardiovascular Surgery, Kurashiki Central Hospital Objective: To present results of our mitral valve surgery for patients with ischemic mitral valve regurgitation(IMR) and evaluated the safety and efficacy of Papillary Muscle Surgery(PMS) and Left Ventriculoplasty(LVP) in patients with IMR. Method: The subjects were 122 patients with IMR who underwent operation from 2000 to 2012. The mean age was 69610. Preoperative LVEF was 34611, LVDd was 5968,
S2-6 Complete Papillary Muscle Approximation is Associated with High Durability of Mitral Valve Repair for Ischemic Mitral Regurgitation SATORU WAKASA, YASUSHIGE SHINGU, TOMONORI OOKA, TSUYOSHI TACHIBANA, YOSHIRO MATSUI Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine Objective: Reduction annuloplasty alone for ischemic mitral regurgitation (MR) cannot prevent late recurrence of MR, which relates to mortality. Surgical approach to this etiology is still controversial. Methods and Results: We studied 45 patients who underwent mitral annuloplasty and papillary muscle approximation (PMA) for ischemic MR between 2003 and 2012. Papillary muscles were approximated entirely (cPMA: complete PMA, n532) through a left ventricular (LV) incision or at the tip (iPMA: incomplete PMA, n513) through the cardiac valves. Twenty-three patients with cPMA also underwent LV plasty (LVP). The baseline MR grade, NYHA class, LV end-diastolic diameter, and LV ejection fraction (LVEF) were 2.861.0, 3.260.6, 6766 mm, and 30610%, respectively. There were no differences in those parameters among those with iPMA, cPMA/LVP-, and cPMA/LVP+, though iPMA patients had better LVEF than others. Three patients died before discharge and 12 died during the follow-up. Recurrence of grade 2+ and 3+ MR occurred in 8 and 2 patients, respectively. Recurrence of MR $2+ was associated with mortality (log-rank P50.022). The 4-year freedom rates from recurrence of MR $2+ were 85%, 75%, and 48% for those with cPMA/LVP+, cPMA/LVP-, and iPMA, respectively (log-rank P50.019), though the freedom rates did not differ between those with cPMA/LVP+ and cPMA/LVP- (log-rank P50.98). Conclusions: Complete PMA could be associated with high durability of mitral valve repair for ischemic MR.