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Related Concept Videos

Mitral Valve Prolapse II: Assessment and Management01:22

Mitral Valve Prolapse II: Assessment and Management

IntroductionA range of clinical features characterizes Mitral Valve Prolapse (MVP), but it is important to note that many individuals with MVP are asymptomatic and may remain so throughout their lives. For those who do exhibit symptoms, the following are the key clinical features:Palpitations: This is a common symptom where individuals feel an irregular or rapid heartbeat. Palpitations in MVP are often due to arrhythmias such as premature ventricular contractions or supraventricular tachycardia.
Mitral Regurgitation I: Introduction01:20

Mitral Regurgitation I: Introduction

Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
Mitral Regurgitation II: Clinical Features and Diagnostic Tests01:23

Mitral Regurgitation II: Clinical Features and Diagnostic Tests

Mitral regurgitation (MR) is a valvular heart disorder in which the mitral valve fails to close tightly, allowing blood to leak backward into the heart. Understanding the clinical manifestations, assessment, diagnostic findings, and medical management of MR is crucial to effectively managing affected patients.Clinical Manifestations of Mitral RegurgitationMitral regurgitation can be acute or chronic, each presenting differently and requiring different approaches:1. Acute Mitral...
Mitral Regurgitation III: Medical Management01:25

Mitral Regurgitation III: Medical Management

Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
Mitral Stenosis II: Clinical features and Diagnostic Tests01:23

Mitral Stenosis II: Clinical features and Diagnostic Tests

Mitral stenosis is a heart condition in which the mitral valve, which allows blood to flow from the left atrium to the left ventricle, becomes narrowed or stenotic. This narrowing hinders blood flow and leads to clinical symptoms requiring specific medical evaluations and management strategies. The following overview outlines the clinical symptoms, assessments, diagnostic findings, prevention methods, and treatments for mitral stenosis.Clinical ManifestationsDyspnea (shortness of breath): This...
Mitral Stenosis III: Medical Management01:26

Mitral Stenosis III: Medical Management

Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...

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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Transcatheter Edge-to-Edge Mitral Valve Repair versus Minimally Invasive Mitral Valve Surgery: An Observational

Miriam Silaschi1, Franca Cattelaens1, Hossien Alirezaei1

  • 1Department of Cardiac Surgery, Heart Center Bonn, 53127 Bonn, Germany.

Journal of Clinical Medicine
|April 9, 2024
PubMed
Summary

Mitral transcatheter edge-to-edge valve repair (M-TEER) shows lower survival than minimally invasive surgery initially, but outcomes equalize after matching. M-TEER is less effective at reducing mitral regurgitation and results in higher gradients.

Keywords:
edge-to-edge repairinnovationsmicroinvasive cardiac surgeryminimally invasive cardiac surgerymitral regurgitationmitral valve surgery

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Minimally invasive mitral valve surgery (MIC-MVS) is standard for mitral regurgitation (MR).
  • Mitral transcatheter edge-to-edge valve repair (M-TEER) is used for high-risk patients and increasingly for intermediate-risk patients.
  • Significant baseline differences exist between M-TEER and MIC-MVS cohorts.

Purpose of the Study:

  • To compare the outcomes of M-TEER and MIC-MVS.
  • To evaluate survival, MR reduction, and mitral valve gradients between the two procedures.
  • To assess the impact of patient matching on comparative outcomes.

Main Methods:

  • Retrospective analysis of 723 M-TEER and 123 MIC-MVS procedures (2010-2021).
  • Sensitivity analysis using matched pairs based on age, LVEF, EuroSCORE II, and MR etiology.
  • Comparison of one-year survival, MR grade at discharge, and postprocedural mitral valve gradients.

Main Results:

  • M-TEER patients were older with higher surgical risk (EuroSCORE II) and lower LVEF.
  • One-year survival was lower in M-TEER (91.5%) versus MIC-MVS (97.6%), p=0.04.
  • MR reduction was less effective in M-TEER (24.5% moderate/severe MR) vs. MIC-MVS (6.5%), p<0.01.
  • Matched analysis showed comparable survival, but higher mean mitral valve gradient in M-TEER (4.1 mmHg) vs. MIC-MVS (3.4 mmHg), p=0.04.

Conclusions:

  • Initial lower survival in M-TEER compared to MIC-MVS was mitigated by matching.
  • M-TEER demonstrated less effective MR reduction and higher postprocedural mitral valve gradients.
  • These findings highlight trade-offs between M-TEER and MIC-MVS, particularly in intermediate-risk patients.