PMID- 37396584
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230704
IS  - 2297-055X (Print)
IS  - 2297-055X (Electronic)
IS  - 2297-055X (Linking)
VI  - 10
DP  - 2023
TI  - Urgent transcatheter edge-to-edge repair for severe mitral regurgitation with 
      flail leaflet in critically Ill patients.
PG  - 1197345
LID - 10.3389/fcvm.2023.1197345 [doi]
LID - 1197345
AB  - INTRODUCTION: Degenerative mitral valve disease (DMR) is a common valvular 
      disorder, with flail leaflets due to ruptured chordae representing an extreme 
      variation of this pathology. Ruptured chordae can present as acute heart failure 
      which requires urgent intervention. While mitral valve surgery is the preferred 
      mode of intervention, many patients have significantly elevated surgical risk and 
      are sometimes considered inoperable. We aim to characterize patients with 
      ruptured chordae undergoing urgent transcatheter edge-to-edge repair (TEER), and 
      to analyze their clinical and echocardiographic outcomes. METHODS: We screened 
      all patients who underwent TEER at a tertiary referral center in Israel. We 
      included patients with DMR with flail leaflet due to ruptured chordae and 
      categorized them into elective and critically ill groups. We evaluated the 
      echocardiographic, hemodynamic, and clinical outcomes of these patients. RESULTS: 
      The cohort included 49 patients with DMR due to ruptured chordae and flail 
      leaflet, who underwent TEER. Seventeen patients (35%) underwent urgent 
      intervention and 32 patients (65%) underwent an elective procedure. In the urgent 
      group, the average age of the patient was 80.3, with 41.8% being female. Fourteen 
      patients (82%) received noninvasive ventilation, and three patients (18%) 
      required invasive mechanical ventilation. One patient died due to tamponade, 
      while echo evaluation of the other 16 patients demonstrated successful reduction 
      of >/=2 in the MR grade. Left atrial V wave decreased from 41.6 mmHg to 17.9 mmHg 
      (p < 0.001), and the pulmonic vein flow pattern changed from reversal (68.8%) to 
      a systolic dominant flow in all patients (p = 0.001). After the procedure, 78.5% 
      of patients improved to New York Heart Association (NYHA) class I or II 
      (p < 0.001). There was no significant difference in the overall mortality between 
      the urgent and elective groups, with similar 6 months survival rates for each 
      group. CONCLUSION: Urgent TEER in patients with ruptured chordae and flail 
      leaflets can be safe and feasible with favorable hemodynamic, echocardiographic, 
      and clinical outcomes.
CI  - (c) 2023 Perel, Amsalem, Gilad, Hitter, Maller, Asher, Harari, Marmor, Carasso, 
      Dvir, Glikson and Shuvy.
FAU - Perel, Nimrod
AU  - Perel N
AD  - Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of 
      Medicine, Hebrew University, Jerusalem, Israel.
FAU - Amsalem, Itshak
AU  - Amsalem I
AD  - Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of 
      Medicine, Hebrew University, Jerusalem, Israel.
FAU - Gilad, Or
AU  - Gilad O
AD  - Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of 
      Medicine, Hebrew University, Jerusalem, Israel.
FAU - Hitter, Rafael
AU  - Hitter R
AD  - Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of 
      Medicine, Hebrew University, Jerusalem, Israel.
FAU - Maller, Tomer
AU  - Maller T
AD  - Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of 
      Medicine, Hebrew University, Jerusalem, Israel.
FAU - Asher, Elad
AU  - Asher E
AD  - Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of 
      Medicine, Hebrew University, Jerusalem, Israel.
FAU - Harari, Emanuel
AU  - Harari E
AD  - Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of 
      Medicine, Hebrew University, Jerusalem, Israel.
FAU - Marmor, David
AU  - Marmor D
AD  - Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of 
      Medicine, Hebrew University, Jerusalem, Israel.
FAU - Carasso, Shemy
AU  - Carasso S
AD  - Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of 
      Medicine, Hebrew University, Jerusalem, Israel.
AD  - The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
FAU - Dvir, Danny
AU  - Dvir D
AD  - Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of 
      Medicine, Hebrew University, Jerusalem, Israel.
FAU - Glikson, Michael
AU  - Glikson M
AD  - Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of 
      Medicine, Hebrew University, Jerusalem, Israel.
FAU - Shuvy, Mony
AU  - Shuvy M
AD  - Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of 
      Medicine, Hebrew University, Jerusalem, Israel.
LA  - eng
PT  - Journal Article
DEP - 20230616
PL  - Switzerland
TA  - Front Cardiovasc Med
JT  - Frontiers in cardiovascular medicine
JID - 101653388
PMC - PMC10314125
OTO - NOTNLM
OT  - acute TEER
OT  - acute mitral regurgitation
OT  - criticall illness
OT  - flail leaflet
OT  - ruptured chordae
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2023/07/03 13:05
MHDA- 2023/07/03 13:06
PMCR- 2023/01/01
CRDT- 2023/07/03 11:22
PHST- 2023/03/30 00:00 [received]
PHST- 2023/05/26 00:00 [accepted]
PHST- 2023/07/03 13:06 [medline]
PHST- 2023/07/03 13:05 [pubmed]
PHST- 2023/07/03 11:22 [entrez]
PHST- 2023/01/01 00:00 [pmc-release]
AID - 10.3389/fcvm.2023.1197345 [doi]
PST - epublish
SO  - Front Cardiovasc Med. 2023 Jun 16;10:1197345. doi: 10.3389/fcvm.2023.1197345. 
      eCollection 2023.