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Background Symptomatic tricuspid regurgitation (TR) is increasingly prevalent and impairs quality of life and survival, despite medical treatment. Transcatheter tricuspid valve repair (TTVR) has recently become available as a treatment option for patients not eligible for tricuspid valve surgery. In this study we describe the early experience with TTVR in the Netherlands. Methods All consecutive patients scheduled for TTVR in two tertiary hospitals were included in the current study. Patients were symptomatic and had severe functional TR. TTVR was performed either with the MitraClip (off-label use) or dedicated TriClip delivery system and device. Procedural success was defined as achievement of clip implantation, TR reduction ≥ 1 grade and no need for re-do surgical or transcatheter intervention. Clinical improvement was evaluated after 4 weeks. Results Twenty-one patients (median age 78 years, 33% male, 95% New York Heart Association class ≥ 3, 100% history of atrial fibrillation) underwent TTVR. Procedural success was achieved in 16 patients, of whom 15 reported symptomatic improvement (New York Heart Association class 1 or 2). There was no in-hospital mortality and no major complications occurred. Baseline glomerular filtration rate and TR coaptation gap size were associated with procedural success. Conclusion The current study showed that TTVR seems a promising treatment option for patients with severe functional TR deemed high risk for surgery. Successful TR reduction is most likely in patients with limited coaptation gap size and strongly determines clinical benefit. Adequate patient selection and timing of treatment seem essential for an optimal patient outcome.

Mitral regurgitation is one of the most prevalent valvulopathies worldwide, and its surgical treatment is not feasible in all cases. The elderly and frail with several comorbidities and left ventricular dysfunction are often managed conservatively. Percutaneous treatment (repair or replacement) of the mitral valve has emerged as a potential option for those patients who are at a high risk for surgery. Mitral valve repair with the Mitraclip device proved both increased safety and mortality reduction in patients with severe mitral regurgitation. On the other hand, in the last decade, percutaneous mitral replacement opened new frontiers in the field of cardiac structural interventions. There are few mitral devices; some are in the early phase of development and some are waiting for CE mark of approval. The evolution of these devices was more complicated compared to the aortic technology due to the native mitral valve's complexity and access. This review aims to provide an overview of the current devices, their specific features, and their potential complications.

Mitral valve disease affects more than 4 million people in the United States and it is the second most prevalent valvulopathy in Europe. The gold standard of treatment in these patients is surgical repair or mitral valve replacement. In the last decade, numerous transcatheter therapies have been developed to overcome the increased number of subjects with symptomatic severe mitral regurgitation and high surgical risk. The Mitraclip (Abbott Vascular, Menlo Park, CA), PASCAL (Edwards Lifesciences, Irvine, CA, USA), the Carillon™ Mitral Contour System™ (Cardiac Dimension Inc., Kirkland, WA, USA), the Mitralign™ (Mitralign, Tewksbury, Massachusetts), and the Cardioband (Edwards Lifesciences, Irvine, CA) are the principal percutaneous devices for mitral valve repair. We present an evidence-based clinical update that provides an overview of these technologies and their potential complications.

AIMS: Treatment strategies of high-risk patients with mitral regurgitation (MR) differ between disease based on functional and disease based on degenerative origin. In the present study, we aimed to evaluate the effect of surgical, percutaneous, or conservative treatment of MR according to MV mechanism, for high-risk patients. METHODS AND RESULTS: Survival outcomes of MitraClip, surgical, or conservative strategies were compared for 688 high-risk patients with functional MR and 275 with degenerative MR. Cox regression and propensity analyses were used to correct for differences in baseline characteristics. For functional MR, conservative treatment proved to have a higher mortality hazard when compared to MitraClip treatment (hazard ratio [HR] 1.79, 95% confidence interval [CI]: 1.34 to 2.39, p

PURPOSE OF REVIEW: This review aims to provide an updated overview and a clinical perspective on novel transcatheter tricuspid valve interventions (TTVI), highlighting potential challenges and future directions. RECENT FINDINGS: Severe tricuspid regurgitation (TR) is a predictor of mortality. However, a sizeable number of patients remain untreated until the end-stage when cardiac surgery presents a prohibitive risk. The emergent need in finding a treatment for patients with TR, deemed for surgery options, has encouraged the development of TTVI. These procedures mimic classical surgery techniques and are mainly divided in four categories: annuloplasty and coaptation devices, edge-to-edge techniques and transcatheter tricuspid valve replacement. Early studies showed promising results, but long-term follow-up data are not available. For patients with severe TR and high surgical risk, several percutaneous options are available. However, these therapies are in a growing phase and bigger studies and long term follow-up are needed to prove their efficacy.

Objectives To evaluate long-term survival in high surgical risk patients undergoing percutaneous mitral valve repair (MVR) using the MitraClip® system and to identify preprocedural predictors of long-term mortality. Background Data for long-term survival and preprocedural predictors of mortality after percutaneous MVR in high surgical risk patients are sporadic. Methods From January 2009 to April 2013, 136 consecutive high surgical risk patients, with symptomatic moderate-to-severe or severe mitral regurgitation (MR), underwent percutaneous MVR using the MitraClip system. Cardiac and overall survival was determined at one and 2 years postprocedure. Univariate and multivariate analysis was performed to identify preprocedural predictors of long-term mortality. Results One year postprocedure, cardiac and overall survival was 86.7% and 84.6%, respectively and at 2 years cardiac and overall survival was 77.7% and 74.8%, respectively. In univariate analysis advanced age, lower body mass index, impaired renal function, elevated levels of log-N-terminal-pro-brain-natriuretic-peptide (log-NTproBNP), poor performance in functional tests (New York Heart Association (NYHA) class) and high logistic Euroscore (LES) and Society of Thoracic Surgeons (STS) score were identified as preprocedural predictors of long-term cardiac mortality. In multivariate analysis preoperative NYHA class III and IV, elevated levels of log-NTproBNP and advanced age predicted long-term cardiac mortality. Conclusions Percutaneous MVR using the MitraClip system has favorable long-term survival rates in high surgical risk patients. Preprocedural NYHA functional class III and IV, elevated log-NTproBNP levels and advanced age predict higher long-term cardiac mortality and should be considered during patient selection. © 2015 Wiley Periodicals, Inc.

Background— Survival outcome after MitraClip treatment, compared with surgical or conservative treatment, is not well defined. We examined survival after MitraClip treatment in a large multicenter real-life setting. Methods and Results— We retrospectively formed matched high-risk surgically and conservatively treated control cohorts to compare to a high-risk MitraClip cohort. One thousand thirty-six patients were included in 4 Dutch centers, of which 568 were treated with the MitraClip. The observed survival at 5-year follow-up in our MitraClip cohort was low (39.8%) but was comparable to our conservative cohort (40.5%). Observed 5-year survival for our surgical cohort was 76.3%. However, there were significant differences between the baseline characteristics of the 3 studied cohorts, with the MitraClip cohort having the highest comorbidity burden. After adjusting for baseline differences by using Cox regression, the MitraClip and surgical cohorts showed similar survival ratios (hazard ratio, 0.92; 95% confidence interval, 0.67–1.26; P =0.609), whereas both showed a lower mortality hazard when compared with conservative treatment (hazard ratio, 0.61; 95% confidence interval, 0.49–0.77; P P Conclusions— This matched analysis suggests a lower mortality hazard for MitraClip intervention in a high-risk population with symptomatic mitral regurgitation when compared with conservative management alone.

Percutaneous edge-to-edge mitral valve (MV) repair is a relatively new treatment option for mitral regurgitation (MR). After the feasibility and safety having been proved in low-surgical-risk patients, the use of this procedure has shifted more to the treatment of high-risk patients. With the absence of randomized controlled trials (RCT) for this particular subgroup, observational studies try to add evidence to the safety aspect of this procedure. These also provide short- and mid-term mortality figures. Several mortality predictors have been identified, which may help the optimal selection of patients who will benefit most from this technique. In this article we provide an overview of the literature about mortality and its predictors in patients treated with the percutaneous edge-to-edge device.

Objectives This study sought to assess the feasibility and safety of percutaneous edge-to-edge mitral valve (MV) repair in patients with an unacceptably high operative risk. Background MV repair for mitral regurgitation (MR) can be accomplished by use of a clip that approximates the free edges of the mitral leaflets. Methods All patients were declined for surgery because of a high logistic EuroSCORE (>20%) or the presence of other specific surgical risk factors. Transthoracic echocardiography was performed before and 6 months after the procedure. Differences in New York Heart Association (NYHA) functional class, quality of life (QoL) using the Minnesota questionnaire, and 6-min walk test (6-MWT) distances were reported. Results Fifty-five procedures were performed in 52 patients (69.2% male, age 73.2 ± 10.1 years, logistic EuroSCORE 27.1 ± 17.0%). In 3 patients, partial clip detachment occurred; a second clip was placed successfully. One patient experienced cardiac tamponade. Two patients developed inguinal bleeding, of whom 1 needed surgery. Six patients (11.5%) died during 6-month follow-up (5 patients as a result of progressive heart failure and 1 noncardiac death). The MR grade before repair was ≥3 in 100%; after 6 months, a reduction in MR grade to ≤2 was present in 79% of the patients. Left ventricular (LV) end-diastolic diameter, LV ejection fraction, and systolic pulmonary artery pressure improved significantly. Accompanied improvements in NYHA functional class, QoL index, 6-MWT distances, and log N-terminal pro–B-type natriuretic peptide were observed. Conclusions In a high-risk population, MR reduction can be achieved by percutaneous edge-to-edge valve repair, resulting in LV remodeling with improvement of functional capacity after 6 months.

Background. Percutaneous mitral valve (MV) repair using the edge-to-edge clip technique might be an alternative for patients with significant mitral regurgitation (MR) and an unacceptably high risk for operative repair or replacement. We report the short-term safety and efficacy of this new technique in a high-risk population. Methods. All consecutive high-risk patients who underwent percutaneous MV repair with the Mitraclip® between January and August 2009 were included. All complications related to the procedure were reported. Transthoracic echocardiography for MR grading and right ventricular systolic pressure (RVSP) measurement were performed before, and at three and 30 days after the procedure. Differences in NYHA functional class and quality of life (QoL) index were reported. Results. Nine patients were enrolled (78% male, age 75.9±9.0 years, logistic EuroSCORE 33.8±9.0%). One patient developed inguinal bleeding. In one patient partial clip detachment occurred, a second clip was placed successfully. The MR grade before repair was ≥3 in 100%, one month after repair a reduction in MR grade to ≤2 was present in 78% (p=0.001). RVSP decreased from 43.9±12.1 to 31.6±11.7 mmHg (p=0.009), NYHA functional class improved from median 3 (range 3 to 4) to 2 (range 1 to 4) (p=0.04), and QoL index improved from 62.9±16.3 to 49.9±30.7 (p=0.12). Conclusion. In high-risk patients, transcatheter MV repair seems to be safe and a reduction in MR can be achieved in most patients, resulting in a short-term improvement of functional capacity and QoL. (Neth Heart J 2010;18:437–43.)

Background— Sirolimus-eluting stents markedly reduce the risk of restenosis compared with bare metal stents. However, it is not known whether there are differences in effectiveness between bare metal and sirolimus-eluting stents in patients with total coronary occlusions. Methods and Results— In a prospective, randomized, single-blind, 2-center trial, we enrolled 200 patients with total coronary occlusions: Half (n=100) were randomly assigned to receive bare metal BxVelocity stents and half (n=100) to receive sirolimus-eluting Cypher stents. The primary end point was angiographic binary in-segment restenosis rate at 6-month follow-up. Secondary end points were a composite of major adverse cardiac events, target vessel failure, binary in-stent restenosis rate, in-stent and in-segment minimal lumen diameter, percent diameter stenosis, and late luminal loss at 6-month follow-up. The sirolimus stent group showed a significantly lower in-stent binary restenosis rate of 7% compared with 36% in the bare metal stent group ( P P P Conclusions— In patients with total coronary occlusions, use of the sirolimus-eluting stents are superior to the bare metal stents with significant reduction in angiographic binary restenosis, resulting in significantly less need for target lesion and target vessel revascularization.

Objective To assess the occurrence of arterial remodelling types and its relation with the severity of luminal stenosis in atherosclerotic coronary arteries. Patients and methods Twenty one de novo coronary lesions of 20 patients, who were scheduled for percutaneous transluminal coronary angioplasty (PTCA), were investigated with intravascular ultrasound before PTCA. Local arterial remodelling at the lesion site was studied by measuring the cross sectional area circumscribed by the external elastic lamina (EEL) relative to the reference site: (EEL area lesion/reference EEL area) × 100%. Three groups were defined. Group A: relative EEL area of less than 95% (shrinkage), group B: relative EEL area between 95% and 105% (no remodelling), group C: relative increase in EEL area of more than 105% (compensatory enlargement). Results All three types of remodelling were observed at the lesion site: group A (shrinkage) n = 8, group B (no remodelling) n = 5, group C (compensatory enlargement) n = 8. The mean (SD) relative EEL area at the lesion site in group A and C was 83(9)% and 132(30)%, respectively. In group A, 33% of the luminal area stenosis at the lesion site was caused by shrinkage of the artery. In contrast, group C showed that 87% of the plaque area did not contribute to luminal area stenosis because of compensatory arterial enlargement. Conclusions These results show that both compensatory enlargement and paradoxical shrinkage occurs in the atherosclerotic coronary artery. Next to plaque accumulation, the type of atherosclerotic remodelling is an important determinant of luminal narrowing.

B genetic and environmental factors are involved in the development of coronary artery disease (CAD). The degree of contribution of each individual risk factor on CAD is unknown. The influence of genetics in the development of CAD could be clarified by investigation of twins. A large cohort of twins with CAD had a significantly higher concordance of coronary heart death in monozygotic twins than dizygotic twins. This effect declined with age. These observations underscore the genetic influence in the development of CAD. Little is known about the angiographic expression of CAD in twins. To address this issue, we report findings of 2 monozygotic twin pairs with CAD and a systematic review of previous publications on this topic. • • • A search of systematic literature in the electronic database “Medline” via “Pubmed” was performed. With the search string “coronary disease” [MESH] and twin, 191 publications were retrieved. Further selections were made by applying the inclusion criteria: monozygotic twins with CAD, performance of coronary angiography, and case reports. The exclusion criterion was concomitant major congenital heart disease. By reading abstracts 20 publications were selected. Nine of these 20 publications were excluded by reading entire papers, because of (1) no performance of angiography, (2) no inclusion of monozygotic twins; and (3) concomitant major congenital heart disease. One additional publication was found by cross-reference search. Finally, 12 publications were suitable for the present review. A 1-page standard form was developed to process the selected publications systematically. This form was the basis for Table 1. Demographic, clinical, and angiographic characteristics of the retrieved case reports, together with the present twin pairs, were analyzed according to the following definitions: concordant coronary anatomy was defined as similar dominance or balance of the coronary system (according to Baim and Grossmann) between respective members of twin pairs. The extent of CAD was defined as (1) 1-, 2-, or 3-vessel disease according to significant lesions in 1 to 3 major epicardial coronary arteries; (2) diameter stenosis of the coronary artery 50%; (3) significant stenosis of the left main coronary artery reported separately as left main disease; (4) concordant coronary lesion defined as location of a coronary lesion in the same segment (American College of Cardiology/American Heart Association classification) in respective members of twin pairs; (5) 1 lesion in the same coronary segment, considered as 1 lesion; and (6) main lesion of major coronary arteries also including the origin of side branches, considered as 1 stenosis of only the major artery. A Pearson correlation coefficient was applied to correlate continuous data among twin members, and a chi-square test was performed for dichotomous data. Twin 1.1: A 58-year-old women with Canadian Cardiovascular Society classification 3 angina was referred to our hospital for coronary angioplasty. Ischemia was documented during the exercise test. Angioplasty of a type B2 lesion in segment 2 (American College of Cardiology/American Heart Association classification) of the right coronary artery was performed with implantation of a 3.0 20 mm stent (Figure 1). Twin 1.2: Six months later the monozygotic twin sister of twin 1.1 also underwent coronary angioplasty because of class 3 angina and ischemia on exercise testing. Angioplasty of a type B1 lesion of segment 2 of the right coronary artery was performed with implantation of a 3.5 13 mm stent. The left coronary arteries of both twins were normal (Figure 2). Twin 2.1: A 39-year-old patient was admitted to our hospital with class 4 angina. He had 3-vessel disease on the coronary angiogram (type B1 lesion in segment 2, type A lesion in segment 7, type B2 lesion in segment 11, and type B1 lesion in segment 12). Coronary artery bypass surgery was performed (Figure 3). Twin 2.2: A 34-year-old male patient, monozygotic twin brother of twin 2.1, was admitted to our hospital because of an acute inferior wall myocardial infarction and was treated with fibrinolysis. Because of postinfarction angina pectoris, coronary angiography was performed and 2-vessel coronary disease was found (type B1 lesion in segment 2 and type B2 lesion in segment 8, Figure 4). He also underwent a coronary artery bypass surgery. Twelve publications composed of 16 monozygotic twin pairs with angiographic assessment of CAD were found. Together with the 2 twin pairs of the present study, data of 18 twin pairs with documented CAD are listed in Table 1. Most patients were men (13 of 18). The age at which twins experienced their first coronary event was 42 12 years (mean SD), with From the Heart Lung Center Utrecht, Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands. Dr. Stella’s address is: Department of Cardiology, University Medical Center Utrecht, Room E01-207, PO Box 85500, 508 GA Utrecht, The Netherlands. E-mail: pstella@hli.azu.nl. Manuscript received September 25, 2001; revised manuscript received and accepted January 4, 2002.

A 45-year-old male patient, with a history of ischemic cardiomyopathy, peripheral arterial disease, and renal dysfunction, was admitted for percutaneous mitral valve repair. Cardiac magnetic resonance imaging showed an ejection fraction of 18% without viability. Severe mitral regurgitation (MR)

Intracoronary ultrasound (ICUS)-guided interventions imply online decision making. We investigated the on- and off-line interobserver variability in ICUS measurements and evaluated the clinical implication of the interobserver variability for ICUS-guided interventions in 40 lesions (38 patients). On the same recorded ICUS images, an online and an off-line observer independently selected and analyzed the proximal and distal reference images, the most severe stenosis image before intervention and the minimal lumen area (MLA) image after intervention. In addition, the off-line observer analyzed the online selected images. The interobserver variability (percentage difference between the two observers) of ICUS measurements was determined on images independently selected by both observers (Analysis A) and on images selected by the online observer (Analysis B). The balloon size was determined from ICUS measurements according to the CLOUT trial. After intervention, the CLOUT and MUSIC criteria for MLA by ICUS had to be fulfilled for PTCA and stent procedures, respectively. In Analysis A, the on- and off-line interobserver variability in diameter and area measurements was maximally 9% and 18%, respectively. In Analysis B, the on- and off-line interobserver variability was maximally 6% and 11%, respectively. The off-line observer would have chosen a balloon size differing by more than 0.25 mm in 25% (10 of 40) and 12.5% (5 of 40) of the procedures in Analysis A and B, respectively. After PTCA or stenting, the off-line observer would have taken different procedural decisions in 19% or 15% and in 13% or 7% of the procedures in Analysis A and B, respectively. In conclusion: when the same location was selected, the on- and off-line interobserver variability was low. When different locations were selected, however, the interobserver variability resulted in different balloon sizing in 25% of the cases. Interobserver variability may be a confounding factor in the analysis of ICUS-guided interventions.

BACKGROUND: The type of remodeling of the human femoral artery (enlargement or shrinkage) is related to the percentage luminal stenosis. OBJECTIVE: To assess how local changes in vessel size, together with plaque load, determine luminal narrowing in atherosclerotic human coronary arteries. METHODS: We obtained 576 segments of 28 coronary arteries from 10 patients who had died from noncardiac causes. The lumen area and area circumscribed by the internal elastic lamina (IEL) area, a measure of local vessel size in each histologic cross-section were measured, and the mean lumen diameter and mean IEL diameter were calculated. To correct for arterial tapering, expected reference diameter values were calculated at the same location using linear regression of all data points along the artery. The IEL diameter and lumen diameter were expressed as percentages of the calculated IEL diameter and lumen diameter at the same location (percentage lumen diameter stenosis and relative IEL diameter, respectively). RESULTS: We found a negative relation between the relative IEL diameter and the percentage lumen diameter stenosis. On average, a narrower than expected lumen diameter was accompanied by a smaller than expected IEL diameter. A larger than expected lumen diameter was accompanied by a larger than expected IEL diameter. This relation was found for the left anterior descending, circumflex, and right coronary arteries (y = -0.60x + 105.33, r = 0.48; y = -0.45x + 100.69, r = 0.84; and y = -0.39x + 101.84, r = 0.61, respectively, all P

Purpose: The Logistic Euroscore (LES) and Society of Thoracic Surgeons (STS) score are used to identify high-risk or inoperable patients eligible for percutaneous Mitral Valve (MV) repair, using the edge-to-edge clip technique. We aimed to examine the correlation between LES and STS scores, and the performance characteristics in patients who underwent percutaneous MV repair. Methods: In total, 87 high-risk patients who underwent percutaneous MV repair using edge-to-edge technique between 01-2009 and 01-2013 were included. The performance of the LES and STS scores was evaluated. Results: The mean age of the included patients was 76.6±9.3 years (70.1% male), with a NYHA functional class ≥ 3 in 93.1%. The combination of in-hospital or 30-days mortality rate was 3.4%. The mean LES was 25.2±15.7%, and mean STS score 13.7±8.6%. A LES of ≥ 20% was present in 54% and a STS score ≥ 10% in 61% of patients. The Pearson correlation coefficient showed a moderate association between LES and STS score (r = 0.64, p

Purpose: Percutaneous Mitral Valve (MV) repair using the edge-to-edge technique is increasingly used in high-risk patients with symptomatic severe MV insufficiency. We report the all-cause mortality rates in patients who underwent percutaneous MV repair. Methods: In total, 87 high-risk patients who underwent percutaneous MV repair using the edge-to-edge technique between 01-2009 and 01-2013 were included. The one and two years survival rates were reported. Results: The mean age of the included patients was 76.6±9.3 years (70.1% male), with a NYHA functional class ≥ 3 in 93.1% and a logistic EuroScore of 25.2±15.7%. During a mean follow up of 1.5±1.1 years (range 0 – 4.0 years) 21 patients (24.1%) died. The in-hospital mortality rate was 3.4%. The one- and two years survival rates were 86.3% and 73.6%, respectively. At baseline, the survivors were younger (73.3±5.1 years versus 78.7±9.9 years, HR 1.1 95% CI 1.0-1.2, p=0.005), had a lower NYHA functional class (3.1±0.5 versus 3.4±0.6, HR 3.1 95% CI 1.3-7.4, p=0.01), and lower logistic NT pro BNP level (7.7±1.0 pg/ml versus 8.4±1.0 pg/ml, HR 1.6 95% CI 1.1-2.3, p=0.01). Age and logistic NT pro BNP level were both independent predictors for mortality after correction for NYHA functional (HR 1.1, p=0.002 for age, HR 1.9, p=0.006 for logistic NT pro BNP). Conclusion: The all-cause mortality rate after percutaneous MV repair using the edge-to-edge technique in high risk patients seems to be acceptably high and might be predicted by age and NT pro BNP.

ObjectivesThe goal of this study was to compare survival between transcatheter mitral valve (MV) repair using MitraClip system (Abbott Vascular, Santa Clara, California), MV-surgery, and conservative treatment in high-surgical-risk patients symptomatic with severe mitral valve regurgitation (MR).BackgroundUp to 50% of patients with symptomatic severe MR are denied for surgery due to high perioperative risk. Transcatheter MV repair might be an alternative.MethodsConsecutive patients (n = 139) treated with transcatheter MV repair were included. Comparator surgically (n = 53) and conservatively (n = 59) treated patients were identified retrospectively. Surgical risk was based on the logistic European System for Cardiac Operative Risk Evaluation (log EuroSCORE) or the presence of relevant risk factors, as judged by the heart team.ResultsThe log EuroSCORE was higher in the transcatheter MV repair group (23.9 ± 16.1%) than in the surgically (14.2 ± 8.9%) and conservatively (18.7 ± 13.2%, p < 0.0001) treated patients. Left ventricular ejection fraction was higher in surgical patients (43.9 ± 14.4%, p = 0.003), with similar values for the transcatheter MV repair (36.8 ± 15.3%) and conservatively treated (34.5 ± 16.5%) groups. After 1 year of follow-up, the transcatheter MV repair and surgery groups showed similar survival rates (85.8% and 85.2%, respectively), whereas 67.7% of conservatively treated patients survived. The same trend was observed after the second and third years. After weighting for propensity score and controlling for risk factors, both the transcatheter MV repair (hazard ratio [HR]: 0.41, 95% confidence interval [CI]: 0.22 to 0.78, p = 0.006) and surgical (HR: 0.52, 95% CI: 0.30 to 0.88, p = 0.014) groups showed better survival than the conservatively treated group. The transcatheter MV repair and surgical groups did not differ (HR: 1.25, 95% CI: 0.72 to 2.16, p = 0.430).ConclusionsDespite a higher log EuroSCORE, high-surgical-risk patients with symptomatic severe MR treated with transcatheter MV repair show similar survival rates compared with surgically treated patients, with both displaying survival benefit compared with conservative treatment.

Objective: Cardiopulmonary bypass and global cardiac arrest enable safe coronary artery bypass grafting but have adverse effects. In off-pump coronary bypass grafting, invasiveness is reduced, but anastomosis suturing is jeopardized by cardiac motion. Therefore the key to successful off-pump coronary bypass grafting is effective local cardiac wall stabilization. Methods: We prospectively assessed the safety and efficacy of the Octopus tissue stabilizer (Medtronic, Inc., Minneapolis, Minn.) in the first 100 patients selected for off-pump coronary bypass via full or limited surgical access. To immobilize and expose the coronary artery, two suction paddles (–400 mm Hg), fixed to the operating table-rail by an articulating arm, stabilized the anastomosis site. Results: One hundred forty-one grafts (96% arterial) were used to create 172 anastomoses (17% side-to-side), up to 4 per patient, on average 2.3 in the full access group (46 patients) and 1.2 in the limited access group (54 patients). Complications included conversion to cardiopulmonary bypass (2%), conversion from limited to full access (3%), myocardial infarction (4%), predischarge coronary reintervention (2%), and late coronary reintervention (1%). Median postoperative length of hospital stay was 4 days (limited access) or 5 days (full access). Rapid recovery allowed 96% of patients to resume social activities within 1 month. At the 6-month angiographic follow-up, 95% of anastomoses was patent. At the 2- to 22-month follow-up (mean, 13 months), 98 patients were in Canadian Cardiovascular Society class I and 2 patients were in class II. Conclusion : These results suggest that off-pump coronary artery bypass grafting with the Octopus tissue stabilizer is safe. Early clinical outcome and patency rates warrant a randomized study comparing this methods with conventional coronary bypass grafting. (J Thorac Cardiovasc Surg 1998;116:60-7)