Impact of the Commercial Introduction of Transcatheter Mitral Valve Repair on Mitral Surgical Practice.

Background There has been uncertainty regarding the effect of transcatheter mitral valve repair (TMVr) with MitraClip on cardiac surgical practice. Our aim was to examine the impact of the commercial introduction of TMVr to a comprehensive mitral program. Methods and Results We evaluated 875 patients (aged 69±14 years; 58% men) who underwent transcatheter or mitral surgical procedures over a 6-year period at our institution. Main outcomes were changes in surgical procedural volume after TMVr introduction and short-term mortality for surgical and TMVr procedures. The numbers of patients treated with MitraClip, isolated mitral repair, and any mitral surgery were 249, 292, and 626 patients, respectively. Compared with surgery, patients with MitraClip were older (aged 82±8 versus 64±12 years; P<0.001) and had more severe morbidity. Following the introduction of MitraClip, surgical volumes steadily increased to a rate of 10 (95% CI, 3-7) procedures per year for isolated mitral procedures and 17 (95% CI, 13-20) procedures per year for all mitral surgeries. Both MitraClip and surgical volumes increased at the same rate (P=0.42). In-hospital mortality was 3.2% for MitraClip and 2.1% for all mitral surgeries (P=0.33). At 30 days, survival free of all mortality (P=0.17) and freedom from heart failure rehospitalization (P=0.75) were similar for transcatheter and surgical procedures. Conclusions The commercial introduction of TMVr may be associated with growth in cardiac surgery, without detracting from other therapies, and favorable clinical outcomes for all treated mitral regurgitation patients. These findings demonstrate the potential benefits of complementary therapies in the treatment of patients with mitral regurgitation.

Rapid quantitative assessment of myocardial perfusion: spectral analysis of myocardial contrast echocardiographic images.

We described a novel rapid spectral analysis technique performed on raw digital in-phase quadrature (IQ) data that quantitatively differentiated perfused from nonperfused myocardium based on the simultaneous comparison of local fundamental and harmonic frequency band intensity levels. In open-chest pigs after ligation of the left anterior descending coronary artery (LAD) and continuous venous contrast infusion, the fundamental-to-harmonic intensity ratio (FHIR) for samples placed within the left ventricular (LV) cavity (10.8 +/- 1.7 dB) and perfused myocardium (13.7 +/- 1.6 dB) were significantly (P <.001) lower than for nonperfused myocardium (27.1 +/- 2.9 dB). In attenuated images, the FHIR for the LV cavity and perfused myocardium were also significantly (P <.05) lower than for the nonperfused myocardium (21.4 +/- 3.0 dB, 34.4 +/- 3.2 dB, and 40.2 +/- 4.4 dB, respectively). Spectral properties of contrast microbubbles, as characterized by the FHIR, allow for rapid quantitative assessment of myocardial perfusion from data contained in a single-image frame, without requiring background image subtraction and image averaging.