Reverse cardiac remodeling in patients undergoing combination therapy of transcatheter mitral valve repair

Figures

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  FIGURE 1. All three combination (COMBO) strategies with blue: Cardioband + mitral transcatheter edge-to-edge repair (M-TEER) (A–E), red: Carillon Mitral Contour System (CMCS) + M-TEER (F–H), and orange: Neochord + M-TEER (I–K). Blue: Cardioband is implanted using fluoroscopy [A + B; “Cardioband (CB)” and arrows] and 3D echocardiography (D). Intermittently, unimpaired flow of left circumflex coronary artery (LCX) is checked (B). Red: CMCS is implanted using fluoroscopy (F + G). Intermittently, unimpaired flow of LCX is checked (F). Note the pull of the CMCS in the left atrium displayed in 3D echocardiography (arrows). Orange: Neochord is implanted using echocardiography [2D: (I) and 3D: (J)]. Please note the open jaws of the NeoChord Implanting system, ready to grasp the flailing posterrior mitral leaflet (*). MC is implanted second to either Cardioband (C,E), CMCS (G,H), or Neochord (K), using both fluoroscopy, and 3D echocardiography (╪).

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  FIGURE 2. (IA–ID): A representative case of severe SMR treated with M-TEER and CMCS. (IA,IB) Fluoroscopic images. (IA) At first CMCS was inserted into coronary sinus, followed by M-TEER (IB). (IC,ID) Transesophageal echocardiographic images during procedure. (IC) Before CMCS was inserted. (ID) After both CMCS and M-TEER were implanted. The change of MR severity was from severe to mild. (II) Kaplan Meyer curve of all-cause death of all patients treated with COMBO-TMVr (n = 35). (IIIA) Serial New York Heart Association functional class, and (IIIB) serial severity of mitral regurgitation. (IV) Favorable ranges of use for different devices: (-); not applicable, [(+)]; useable, (+++) favorable use. CMCS, Carillon Mitral Contour System; LVEF, left ventricular ejection fraction; LVESV, left ventricular end-systolic volume; LVEDV, left ventricular end-diastolic volume; LV mass, left ventricular mass; LAVi, left atrial volume index; M-TEER, transcatheter edge-to-edge repair; MR, mitral regurgitation; NYHA, New York Heart Association.

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  FIGURE 3. (A) Change ratio of left ventricular and left atrial parameters between at baseline and at 1 year after the procedure, and (B) difference of BNP at 1 month and at 1 year after the procedure compared with baseline. LVESD, left ventricular end-systolic diameter; LVEDD, left ventricular end-diastolic diameter; LVESV, left ventricular end-systolic volume; LVEDV, left ventricular end-diastolic volume; LV mass, left ventricular mass; LAVi, left atrial volume index; BNP, brain natriuretic peptide, “°” and “*” denote outliers.