PMID- 32915515 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20221110 IS - 2055-5822 (Electronic) IS - 2055-5822 (Linking) VI - 7 IP - 6 DP - 2020 Dec TI - Association of transcatheter direct mitral annuloplasty with acute anatomic, haemodynamic, and clinical outcomes in severe mitral valve regurgitation. PG - 3336-3344 LID - 10.1002/ehf2.12957 [doi] AB - AIMS: Several approaches for transcatheter mitral valve repair for functional mitral valve regurgitation are established. Interventional direct annuloplasty is a novel trans-venous, trans-septal approach. While feasibility was proven recently, knowledge on its influence on cardiac dimensions, pressures, biomarkers, and clinical outcomes is sparse. METHODS AND RESULTS: Patients consecutively treated with direct annuloplasty-only procedures between December 2015 and April 2018 were included in this monocentric analysis. Echocardiographic measurements, biomarker levels, clinical status [New York Heart Association (NYHA) class and 6 min walk test] were assessed at baseline, at discharge, and at a 30 day follow-up. Overall, 18 patients (in mean 77.0 +/- 7.4 years, 44.4% women) with initially all high-grade mitral valve regurgitation (MR) were included in this study. Procedural success rate was high (94.4%) without severe complications. Direct annuloplasty resulted in MR-reduction (post-procedural-MR mild or no/trace: 72.2%) and the proportion of patients with severe dyspnoea (NYHA III/IV) was reduced (88.9% vs. 50%, P = 0.008). Clinical results were associated with a relevant diminution of left atrial volumes (-16.5%, P < 0.001) and cardiac pressures [left atrial pressure (-32.3%, P = 0.019) and systolic pulmonary arterial pressure (PAP, -15.8%, P = 0.025)]. Patients with lower baseline levels of PAP (P = 0.022) as well as elevated highly sensitive troponin (P = 0.034) were more likely to archive clinical benefit (improvement in NYHA class >/=1 grade) after 1 month, which could not be correlated with the grade of MR-reduction. CONCLUSIONS: Transcatheter mitral valve repair by direct annuloplasty results in a relevant reduction of intracardiac pressures, left atrial volumes, dyspnoea, and MR. Lower PAP and higher troponin values at baseline could be associated to dyspnoea reduction. CI - (c) 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. FAU - Geyer, Martin AU - Geyer M AD - Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany. FAU - Keller, Karsten AU - Keller K AD - Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany. AD - Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany. FAU - Sotiriou, Efthymios AU - Sotiriou E AD - Department of Cardiology, Klinikum Mutterhaus Mitte, Trier, Germany. FAU - Tamm, Alexander R AU - Tamm AR AD - Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany. FAU - Ruf, Tobias F AU - Ruf TF AD - Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany. FAU - Kreidel, Felix AU - Kreidel F AD - Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany. FAU - Beiras-Fernandez, Andres AU - Beiras-Fernandez A AD - Department of Cardiothoracic and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany. FAU - Gori, Tommaso AU - Gori T AD - Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany. AD - Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany. AD - German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany. FAU - Schulz, Eberhard AU - Schulz E AD - Department of Cardiology, AKH Celle, Celle, Germany. FAU - Munzel, Thomas AU - Munzel T AD - Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany. AD - German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany. FAU - von Bardeleben, Ralph Stephan AU - von Bardeleben RS AD - Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, Mainz, 55131, Germany. LA - eng GR - BMBF 01EO1503/Federal Ministry of Education and Research/ GR - BMBF 01EO1503/German Federal Ministry of Education and Research/ GR - German Federal Ministry of Education and Research/ PT - Journal Article DEP - 20200911 PL - England TA - ESC Heart Fail JT - ESC heart failure JID - 101669191 SB - IM PMC - PMC7755018 OTO - NOTNLM OT - Heart failure OT - Mitral valve disease OT - Mitral valve repair OT - Multidisciplinary heart team OT - Transcatheter direct annuloplasty COIS- M.G., K.K., E.S., A.R.T., T.F.R., T.G., and T.M. declare no conflict of interest. F.K. reports having received consultancy and lecture honoraria from Abbott Vascular, Cardiac Implants, and Edwards Lifesciences. A.B.-F. reports having received lecture honoraria from Edwards and consultancy from Abbott Vascular. E.S. reports lecture honoraria from Edwards Lifesciences and Medtronic. R.S.v.B. reports having received consultancy and lecture honoraria from Abbott Vascular, Cardiac Dimensions, Edwards Lifesciences, GE Health Systems, and Philips Healthcare. EDAT- 2020/09/12 06:00 MHDA- 2020/09/12 06:01 PMCR- 2020/09/11 CRDT- 2020/09/11 12:15 PHST- 2020/07/08 00:00 [revised] PHST- 2020/04/07 00:00 [received] PHST- 2020/08/03 00:00 [accepted] PHST- 2020/09/12 06:00 [pubmed] PHST- 2020/09/12 06:01 [medline] PHST- 2020/09/11 12:15 [entrez] PHST- 2020/09/11 00:00 [pmc-release] AID - EHF212957 [pii] AID - 10.1002/ehf2.12957 [doi] PST - ppublish SO - ESC Heart Fail. 2020 Dec;7(6):3336-3344. doi: 10.1002/ehf2.12957. Epub 2020 Sep 11.