See Article page 65.
Presenter: Dr Serdar Akansel
Dr Isaac George(New York, NY). All right. First of all, I want to thank you for really a superb report, which I had the pleasure of reading beforehand. I really enjoyed reading it. It really highlights kind of what we want and everything for great research, which is investigation; validation; and some really, really good innovative techniques. I think the topic is very timely. The need to repair these valves in the era of maybe some overzealous edge-to-edge therapy is very important. And so, I think it meets a critical need in this current time. In my experience, a lot of times the valves have been either so damaged or so encapsulated that I just frankly have not bothered trying to repair them. And other than acute failures, I've just gone ahead and replaced them. But I think your article really highlights the need to take some more time, even in older patients, potentially, if you can really get the clip out and do a good repair. So, I think it's going to hopefully prompt some more of that. I think among the nice features of the report is the experience with the Pascal device, which is still in trial here, and I think very few people have explanted, as opposed to the clip device, which I think a lot of us have experience with. So, I think it's going to be very widely read. I think it's great. I recommend everyone taking a look at the videos. As for the visualization, I have a couple of quick questions. The visualization is excellent in the videos you've shown, and you've done primarily minimally invasive operations. Have you done any through sternotomy, which I suspect is a little more challenging?
Dr Serdar Akansel(Berlin, Germany). Actually, we think that such operations can be also performed through full sternotomy. Actually, if I don't exceed my time, I can mention about our last report regarding operative management after failed transcatheter mitral valve repair replacement procedures. In this cohort, we have evaluated totally 69 patients after failed transcatheter mitral valve repair replacement, and 23 of these patients were operated through in full sternotomy. But actually, as you said, true to minimally invasive setting, it's easier to obtain a better visualization with minimally invasive setting.
Dr George. My next question was about some of the numbers that you reference, how many have you explanted and how many were you able to repair either using this technique or other techniques?
Dr Akansel. So, in this research, we evaluated 46 patients undergoing minimally invasive mitral valve repair after failed transcatheter mitral valve repair replacement procedures. And we have grouped the patients in functional mitral regurgitation and degenerative mitral regurgitation. According to our experience, all patients with functional mitral regurgitation should undergo a mitral valve replacement. And in the degenerative mitral regurgitation group, we considered mitral valve repair. Our decision-making process was based on the anterior mitral leaflet integrity and whether the posterior mitral leaflet is highly damaged. In this cohort, 5 of 10 patients in the degenerative mitral regurgitation group could undergo mitral valve repair. And the other patients received mitral valve replacement. And let me say one more thing: The encapsulation of the device may complicate the damage-free explantation and making mitral valve repair impossible or unfeasible, as you said. So, that's why the interval between transcatheter mitral valve repair replacement procedure and surgery is important and decisive.
Dr George. Last question. Again, congratulations on a great report. Which is easier to remove?
Dr Akansel. Actually, the Pascal was found to be easier for explantation. And let me say that, actually, since the Pascal device has a soft locking system, these techniques can be also combined with cold saline solution to explant easier.
Unidentified Speaker 1. It's really impressive work, although I will say that was in the United States, the repair rate is <10% after it failed here. And I tell you the procedures I've done didn't look like that last 1 where it just popped out. The only procedures I've been able to repair are people that have Barlow's and they have so much leaflet that I can cut it out and I still have enough leaflet to rebuild, but it is very interesting. I do think we need to take more time. But speaking of time, we are now over.
Dr Akansel. Thank you.
Presenter: Serdar Akansel, MD
Invited Discussant: Isaac George, MD
Corresponding Author: Serdar Akansel, MD
Footnotes
This discussion occurred at the 103rd AATS Annual Meeting.
Disclosures: Dr George is a consultant for Vdyne, Mitremedical, Cardiomech, Durvena, Foldax, Neptune Medical, and MITrx. Dr Akansel reported no conflicts of interest.
The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.