Description
List of Contributors xvii Introduction–The Mitral Book xxiii 1 The Pathology of Mitral Valve Disease 1 Maria E. Romero, Sho Torii, and Renu Virmani 1.1 Introduction 1 1.2 General Anatomy of the Mitral Valve 1 1.2.1 Mitral Annulus 1 1.2.2 Leaflets 3 1.2.3 Chordae Tendineae and Papillary Muscles 5 1.2.4 Papillary Muscles and Left Ventricle 5 1.3 Pathology of Mitral Valve 5 1.3.1 Mitral Valve Stenosis 5 1.3.2 Aging Changes and Mitral Annulus Calcification (MAC) 6 1.3.3 Acute Mitral Regurgitation 8 1.3.4 Chronic Mitral Regurgitation 8 1.3.5 Degenerative MR; Myxomatous Degeneration of the Mitral Valve 8 1.3.6 Functional MR 10 References 11 2 The Importance of Minimally Invasive Approaches for Mitral Valve Repair 15 Bobby Yanagawa and Niv Ad 2.1 Introduction to Minimally Invasive Mitral Valve Surgery 15 2.2 The Importance of MICS MVS 16 2.3 Patient Selection 17 2.4 Surgical Setup–Fibrillating Heart MVS 18 2.5 Alternatives for Cannulation 19 2.6 Alternatives to Myocardial Protection 19 2.7 Mitral Valve Repair 20 2.8 Outcomes 20 2.9 Initiating Minimally Invasive Mitral Valve Repair Program 21 2.10 Conclusion 22 References 22 3 When to Intervene–Should Surgical Guidelines Apply to Transcatheter Techniques in Treating Mitral Regurgitation? 25 Samir Kapadia, Rishi Puri, Kinjal Banerjee, and Lars G. Svensson 3.1 Introduction 25 3.2 Primary MR 25 3.2.1 Current Guideline Recommendations 25 3.2.2 Transcatheter Therapies–New Guideline Applications? 26 3.3 Secondary MR 29 3.3.1 Current Guideline Recommendations 29 3.4 Conclusions 31 References 32 4 Transcatheter Mitral Valve Therapies: A Three-Dimensional Echocardiographic View 35 Shmuel Schwartzenberg, Chaim Yosefy, and Alexander Sagie 4.1 Introduction 35 4.1.1 Mitral Valve Anatomy 35 4.1.2 Mitral Valve Structure and Function 35 4.1.3 Mitral Regurgitation Severity 36 4.1.4 Diagnosis of MR Severity: Proximal Isovelocity Surface Area Method 36 4.1.5 Diagnosis of MR Severity: Vena Contracta Method 37 4.1.6 Primary and Secondary MR 37 4.1.7 Mitral Regurgitation and Cardiovascular Death and Morbidity 38 4.1.8 Screening for MitraClip Suitability 40 4.1.9 MitraClip Procedure Guidance 41 4.1.10 Transseptal Puncture 41 4.1.11 MitraClip Delivery Guidance 42 4.1.12 Adequacy of MitraClip Implantation Assessment 43 4.1.13 Other Technologies 45 4.2 Conclusions 45 References 45 5 CMR Assessment of Mitral Regurgitation 51 Daniel Knight and Vivek Muthurangu 5.1 Introduction 51 5.2 Pulse Sequences Used in CMR 52 5.2.1 Cine Imaging 52 5.2.2 Phase Contrast Imaging 52 5.3 Assessment of MR Severity 52 5.3.1 Qualitative Assessment 52 5.3.2 Quantitative Assessment 55 5.3.3 Technical Considerations for the Quantitative Assessment of MR by CMR 56 5.4 Identification of MR Etiology 57 5.4.1 Primary MR 57 5.4.2 Secondary MR 57 5.5 The Role of CMR Assessment of MR in Clinical Practice 58 5.6 Conclusions 58 References 58 6 CT Planning for TMVR and Predicting LVOT Obstruction 63 Dee Dee Wang, Mayra Guerrero, Brian O’Neill, Pedro A. Villablanca Spinetto, James Lee, Tiberio Frisoli, Marvin Eng, and William O’Neill 6.1 Introduction 63 6.2 History of Imaging for Mitral Valve Disease 63 6.2.1 TAVR CT Planning 63 6.2.2 Surgical and Transcatheter Mitral Interventions 63 6.3 Concept of Aortic and Mitral Valve Technology Development 64 6.4 Basics of CT Imaging Acquisition 66 6.5 Definition of Mitral Valve and TMVR device Landing Zone 66 6.6 Definition of LVOT 66 6.7 CT Methods for Neo-LVOT prediction modeling 67 6.8 CT Validation of Neo-LVOT Prediction Modeling Post-TMVR 68 6.9 Correlation Between Pre- and Post-TMVR CT Neo-LVOT Prediction Modeling 69 6.10 What Else Has CT Planning for TMVR Taught Us? 70 Acknowledgments 72 References 72 7 General Principles and State-of-the-Art Echocardiographic Evaluation of the Mitral Valve 75 Federico M. Asch and Diego Medvedofsky 7.1 Introduction 75 7.2 Mechanism and Etiology of Chronic MR 75 7.2.1 Transthoracic Echocardiography 76 7.2.1.1 Assessment of MR Severity 76 7.2.2 Qualitative Assessment 76 7.2.2.1 Color Flow Doppler 76 7.3 Continuous Wave (CW) Density Jet 79 7.3.1 Semi-Quantitative Assessment 79 7.3.1.1 VC Width 79 7.4 Pulmonary Vein Flow/Mitral Inflow 79 7.4.1 Quantitative Assessment 80 7.5 Selection of Best Candidates for Interventions of the Mitral Valve 82 7.5.1 Echocardiographic Criteria of COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) Trial 84 References 84 8 Intraprocedural Echocardiography for MitraClip 87 Philip Haines and Sumbal A. Janjua 8.1 Introduction 87 8.2 Pre-Procedure Evaluation 88 8.3 Importance of the Baseline Study – TEE 88 8.4 The Transseptal Puncture 95 8.5 Guiding MitraClip System to Mitral Valve 98 8.6 Intraprocedural Guidance of Clip within Mitral Valve and Leaflets 102 8.7 Post-Clip-Deployment Assessment of Mitral Valve Function 103 8.8 Assessment of Complications and Iatrogenic ASD 105 References 112 9 Intraprocedural Echocardiography for Transcatheter Mitral Valve Replacement 115 Patrick T. Gleason, John C. Lisko, and Stamatios Lerakis 9.1 Introduction 115 9.2 Baseline Mitral Valve Assessment 115 9.3 Access to the Left Atrium, Left Ventricle, and Mitral Valve 116 9.4 Predeployment and Deployment Monitoring 118 9.5 Postdeployment Evaluation 120 References 122 10 Transcatheter Repair: MitraClip for Degenerative Mitral Regurgitation 125 Ted Feldman 10.1 Surgery for Degenerative Mitral Regurgitation 125 10.2 Evidence Base for MitraClip 125 10.3 Challenges for the MitraClip Procedure 130 10.4 Evaluation of MitraClip for Less than Prohibitive-Risk DMR Patients 131 10.5 Future Directions for MitraClip and Alternative Approaches for Leaflet Repair 133 10.6 Summary 135 References 136 11 MitraClip(TM) for Secondary Mitral Regurgitation 139 Brian J. Forrestal and Toby Rogers 11.1 Introduction 139 11.2 European and US Clinical Practice Guidelines 139 11.3 The MitraClip System 140 11.4 MitraClip Preprocedural Planning 140 11.5 Surgical Outcomes Data 140 11.6 The COAPT and MITRA-FR Trials 141 11.7 Summary and Conclusions 144 References 144 12 The Edwards PASCAL Transcatheter Valve Repair System 147 Mirjam Winkel, Stephan Windecker, and Fabien Praz 12.1 Introduction 147 12.2 The Edwards PASCAL(TM) Transcatheter Valve Repair System 147 12.3 Implantation Procedure 148 12.4 Compassionate-Use and Early Feasibility Data 150 12.5 Future Developments 151 References 152 13 The Development of a Novel Percutaneous Treatment for Secondary Mitral Regurgitation–The Carillon(r) Mitral Contour System(r) 153 Steven L. Goldberg 13.1 Introduction 153 13.2 REDUCE-FMR 157 13.3 The CARILLON Trial 160 13.4 Summary 161 References 161 14 A Fully Percutaneous Mitral Ring: The Cardioband System 163 Antonio Mangieri, Enrico Poletti, and Azeem Latib 14.1 Introduction 163 14.2 Mitral Annulus Anatomy 163 14.3 Pathophysiological Role of the Mitral Annulus in Mitral Regurgitation 164 14.3.1 Mitral Annulus in FMR 164 14.3.2 Mitral Annulus in DMR 164 14.4 Surgical Annuloplasty in Mitral Regurgitation 164 14.5 The Cardioband System: Description of the Device 165 14.6 Procedural Planning 165 14.7 Clinical Studies 168 14.8 Possible Complications Related to the Implantation of Cardioband 170 14.9 Recurrence of Mitral Regurgitation Following Cardioband Implantation 171 14.10 Cardioband in Combination with Other Devices 172 14.11 Conclusions 173 References 173 15 Transcatheter Mitral Cerclage Annuloplasty 175 Christopher Bruce, June-Hong Kim, Toby Rogers, and Robert J. Lederman 15.1 Introduction 175 15.2 Cerclage Anatomy and Function 175 15.3 Limitations of Coronary Sinus Annuloplasty 176 15.4 Cerclage Annuloplasty Device 177 15.5 The Cerclage Procedure 177 15.6 Preclinical Experiments 178 15.7 Initial Human Experience 178 15.8 Future Directions 180 15.9 Summary 182 Competing Interests 183 References 183 16 The Transapical Off-Pump Mitral Valve Repair with the NeoChord Implantation (TOP-MINI) 185 Stefan Bertog, Laura Vaskelyte, Nalan Schnelle, Iris Grunwald, Ilona Hofmann, Sameer Gafoor, Markus Reinartz, Predrag Matic, Bojan Jovanovic, Kolja Sievert, Michle Jaqueline Lembens, and Horst Sievert 16.1 Introduction 185 16.2 Technology 185 16.3 Patient Selection 186 16.4 Procedure 186 16.5 Echocardiographic Guidance 191 16.6 Examples 191 16.6.1 Ideal Anatomy 191 16.6.2 Acceptable Anatomy 191 16.6.3 Challenging Anatomy 192 16.6.4 Data 192 16.7 Conclusion 194 References 195 17 AltaValve(TM)–A Transcatheter Mitral Valve Regurgitation Treatment Technology 197 Katherine Kumar, PhD and Saravana Kumar, PhD 17.1 Clinical Need 197 17.2 Device Description 198 17.2.1 Principle of Operation 198 17.2.2 Device Construction 199 17.2.2.1 Stent 200 17.2.2.2 Stent Cap 200 17.2.2.3 Tissue Valve 200 17.2.2.4 Fabric Skirts and Sutures 200 17.2.3 Delivery Systems 200 17.3 Anatomical Imaging and Sizing 202 17.4 Preclinical and Clinical Experience 203 17.4.1 Animal Studies 203 17.5 Human Clinical Experience 204 17.6 Summary 205 References 206 18 The ARTO Transcatheter Mitral Valve Repair System 209 Andrejs Erglis, Inga Narbute, Agnese Strenge, and Samantha E. Greene 18.1 Device Description 209 18.2 Procedural Details 209 18.3 Clinical Experience with the ARTO System 212 18.4 Unique Features of the ARTO System 216 References 216 19 Transcatheter Mitral Annuloplasty: The Millipede Device 219 Jason H. Rogers and Steven F. Bolling 19.1 Background 219 19.2 The Millipede Device 219 19.3 Millipede Implantation Procedure 220 19.4 Surgical Millipede Implants 220 19.5 Millipede Clinical Results 222 19.6 Clinical Implications 223 19.7 Summary 226 Author Disclosures 226 References 226 20 Transapical and Transseptal Access for Transcatheter Mitral Valve Replacement: Techniques and Devices 227 James Edelman and Vinod H. Thourani 20.1 Introduction 227 20.2 Transapical Approach 227 20.2.1 Technique 228 20.2.2 Devices in Active Clinical Trial Phase 230 20.2.2.1 Tendyne 230 20.2.2.2 Intrepid 230 20.2.2.3 CardiAQ 231 20.2.2.4 TIARA 231 20.2.2.5 HighLife 231 20.3 Transseptal Approach 231 20.3.1 Technique 231 20.3.2 Devices in Active Clinical Trial Phase 233 20.3.2.1 Sapien M3 233 20.3.2.2 EVOQUE 233 20.3.2.3 Caisson 233 20.4 Conclusions 233 References 233 21 Mitral Valve-in-Valve and Valve-in-Ring Therapies 235 Norihiko Kamioka, Peter C. Block, Adam B. Greenbaum, and Vasilis C. Babaliaros 21.1 Overview 235 21.2 Evidence 236 21.3 Procedure Planning 239 21.4 Procedure 243 21.5 Pitfalls and Solutions–POULEZ and LAMPOON 244 References 245 22 Edwards SAPIEN in Native Mitral Annular Calcification (MAC) 251 Mayra Guerrero, Dee Dee Wang, Mackram Eleid, Charanjit Rihal, William O’Neill, and Ted Feldman 22.1 Introduction 251 22.2 Anatomic Considerations and Sizing 251 22.3 Delivery Access Types 253 22.4 Preprocedural Planning 253 22.5 Valve Deployment Technique 253 22.6 Clinical Outcomes and Complications 255 22.7 LVOT Obstruction 256 22.8 TMVR in MAC Clinical Trials 256 22.9 Aortic THV versus Dedicated TMVR Devices for MAC 257 22.10 Conclusions 257 Disclosures 258 References 258 23 Transcatheter Mitral Valve Replacement: The Tendyne Device 261 Alison Duncan 23.1 Introduction 261 23.2 The Tendyne TMVI Device 261 23.2.1 Current Tendyne Device Design 262 23.3 Patient Screening and Preprocedural Imaging 262 23.3.1 Patient Selection 262 23.3.2 Anatomical Screening 263 23.4 Implantation Technique 264 23.4.1 Transapical Approach 264 23.4.2 Device Entry into Left Atrium 264 23.4.3 Intra-annular Device Deployment 264 23.4.4 Apical Pad Fixation and Adjustment of Tether Tension 264 23.4.5 Confirmation of Device Position and Function 267 23.5 Clinical Outcomes 267 23.6 Future Challenges 271 23.7 Conclusion 274 References 274 24 TIARA Transcatheter Mitral Replacement System 277 Anson Cheung 24.1 Introduction 277 24.2 Neovasc TIARA TMVR System 277 24.3 Candidacy for TIARA TMVR 278 24.4 Clinical Case and TIARA TMVR Implantation 278 24.5 Clinical Updates 281 24.6 Conclusions 281 Conflict of Interest 282 References 282 25 Caisson Transcatheter Mitral Valve Replacement System 283 Mathew R. Williams and Cezar S. Staniloae 25.1 Introduction 283 25.2 Caisson Transcatheter Mitral Valve Replacement System Components 283 25.2.1 Anchor 284 25.2.2 Valve 285 25.2.3 The Delivery System 285 25.2.4 Retrieval Accessories 285 25.3 Procedural Details 285 25.3.1 Role of Imaging on Valve Sizing and Procedural Guidance 287 25.3.1.1 Role of Gated CT 287 25.3.1.2 Role of TEE Guidance During the Procedure 288 25.4 Current Status of the Caisson Research Program 289 25.5 Conclusions 289 Reference 289 26 Transcatheter Mitral Valve Replacement with the CardiAQ-Edwards and EVOQUE Prostheses 291 Howard C. Herrmann, Wilson Y. Szeto, and Frank E. Silvestry 26.1 Introduction 291 26.2 Device Description 291 26.3 First-in-Human Transfemoral Case 292 26.4 Initial Experience via Transapical Approach 292 26.5 Second-Generation Transseptal Approach 293 26.6 Current CardiAQ Generation Design and Contemporary Case Example 293 26.6.1 Evolution to EVOQUE TMVR 295 26.7 Discussion 296 References 297 27 Intrepid 299 Eberhard Grube and Jan-Malte Sinning 27.1 Background 299 27.2 The Intrepid Valve Features 300 27.3 Clinical Experience 301 27.4 Discussion 304 References 306 28 Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction (LAMPOON) 309 Jaffar M. Khan and Vasilis C. Babaliaros 28.1 Introduction 309 28.1.1 Mechanism of LVOT Obstruction from TMVR 309 28.1.2 Prediction of LVOT Obstruction 309 28.1.3 Prevention and Treatment of LVOT Obstruction 309 28.2 The LAMPOON Technique 310 28.2.1 CT Planning for TMVR and LAMPOON 311 28.2.2 LAMPOON Equipment 312 28.2.3 Step 1: Positioning the Snare System 312 28.2.4 Step 2: Leaflet Traversal 312 28.2.5 Step 3: Leaflet Laceration 312 28.3 Alternative LAMPOON Techniques 313 28.3.1 Antegrade Transseptal LAMPOON 313 28.3.2 Antegrade Apical LAMPOON 313 28.3.3 “Rescue” LAMPOON 314 28.4 Evidence for LAMPOON-Assisted TMVR 315 28.5 Future Directions 315 28.6 Conclusions 315 References 315 29 Use of Alcohol Septal Reduction Therapy to Facilitate Transcatheter Mitral Valve Replacement 317 Marvin H. Eng, Tiberio Frisoli, Dee Dee Wang, James C. Lee, Pedro A. Villablanca Spinetto, Janet Wyman, and William W. O’Neill 29.1 Introduction 317 29.2 Technique 319 29.3 Safety 321 29.4 Efficacy 321 29.5 Conclusion 323 References 323 30 Direct Transatrial Approach with Resection of the Anterior Mitral Leaflet to Prevent Outflow Tract Obstruction 325 Fabien Praz and Isaac George 30.1 Introduction 325 30.2 Advantages of the Direct Transatrial Access 325 30.3 Patients Selection and THV Sizing 326 30.3.1 Mitral Annulus Sizing 326 30.3.2 Assessment of the Risk of LVOTO Using Valve Simulation 326 30.4 Implantation Techniques 328 30.4.1 First-in-Human and Early Experience 328 30.4.2 Strategies to Prevent Paravalvular Leakage 329 30.5 Surgical Access 329 30.6 Early Outcomes Data 330 30.7 Conclusions 331 References 331 31 Transcatheter Closure of Mitral Paravalvular Leak 333 Tilak K. R. Pasala, Vladimir Jelnin, and Carlos E. Ruiz 31.1 Introduction 333 31.2 Prevalence and Clinical Presentation 333 31.3 Assessment of Mitral PVL 334 31.3.1 Grading of Severity 334 31.3.2 Complexity of Mitral PVL 334 31.3.3 Adjunctive Imaging 334 31.4 Timing of Intervention 335 31.5 Preplanning 336 31.5.1 Location 336 31.5.2 Virtual Planning 337 31.6 Devices Used for PVL Closure 338 31.6.1 Transcatheter Procedure 338 31.6.2 Procedural Guidance 340 31.6.3 Access 340 31.6.4 Procedural Techniques 341 31.6.4.1 Crossing the PVLs 341 31.6.4.2 Catheter and Device Delivery 343 31.6.4.3 Device Deployment 344 31.6.4.4 Hopscotch Technique 345 31.7 Procedural Complications 345 31.8 Follow-Up 346 31.9 Future 346 31.10 Conclusion 346 Disclosures 346 References 346 32 Management of Iatrogenic Interatrial Septal Defect–To Close or not to Close? 349 Christina Tan and James M. McCabe 32.1 Introduction 349 32.2 Hemodynamics and iASDs 349 32.3 Incidence of Persistent Iatrogenic Atrial Septal Defects 350 32.4 Evaluation of Iatrogenic Atrial Septal Defect 351 32.5 Closure 352 32.6 ASD Closure Procedure 352 32.7 Management 353 References 355 33 Antithrombotic Therapy in Transcatheter Mitral Valve Intervention 359 Yuefeng Chen and Ron Waksman 33.1 Introduction 359 33.2 MitraClip System 359 33.2.1 Before the Procedure 359 33.2.2 During the Procedure 360 33.2.3 After the Procedure 361 33.2.4 Thromboembolic and Bleeding Risk 361 33.3 Transcatheter Mitral Valve Replacement 362 33.3.1 Before the Procedure 362 33.3.2 During the Procedure 362 33.3.3 After the Procedure 362 33.3.4 Thromboembolic and Bleeding Risk 363 33.4 Patients with Atrial Fibrillation 365 33.5 Antithrombotic Therapy for Other Mitral Valve Interventions 365 33.6 Conclusions 365 References 366 Index 371
