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. 2021 Jun;9(6):453-462.
doi: 10.1016/j.jchf.2021.03.002. Epub 2021 May 12.

Percutaneous Mitral Valve Annuloplasty in Patients With Secondary Mitral Regurgitation and Severe Left Ventricular Enlargement

Stefan D Anker  1 , Randall C Starling  2 , Muhammad Shahzeb Khan  3 , Tim Friede  4 , Gerasimos Filippatos  5 , JoAnn Lindenfeld  6 , Ralph Stephan von Bardeleben  7 , Andrew J S Coats  8 , Javed Butler  3
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Free article

Percutaneous Mitral Valve Annuloplasty in Patients With Secondary Mitral Regurgitation and Severe Left Ventricular Enlargement

Stefan D Anker et al. JACC Heart Fail. 2021 Jun.
Free article

Abstract

Objectives: This study sought to determine the effect of percutaneous mitral valve annuloplasty with the Carillon device versus guideline-directed medical therapy (GDMT) alone in patients with secondary mitral regurgitation (MR) and severe left ventricular (LV) enlargement.

Background: The clinical impact of the Carillon device in patients with severe LV dilation is not well established.

Methods: This is a pooled analysis involving 3 prospective trials (TITAN [Transcatheter Implantation of Carillon Mitral Annuloplasty Device], TITAN II, and REDUCE FMR [CARILLON Mitral Contour System for Reducing Functional Mitral Regurgitation] trials) in which patients with functional MR and severe LV enlargement (LV end-diastolic diameter >65 mm) were treated with GDMT and the Carillon device versus GDMT alone. Key outcomes of this analysis were changes over 1 year of follow-up in mitral valve and LV echocardiographic parameters, functional outcome, quality of life, mortality, and heart failure hospitalization (HFH).

Results: A total of 95 patients (67 in the Carillon group, 28 in the GDMT group) with severe LV enlargement were included. In the Carillon group, all mitral valve and LV morphology parameters were significantly improved at 1 year. Regurgitant volume decreased by 12 ml (p < 0.001), MR grade decreased by 0.6 U (p < 0.001), LV end-diastolic volume decreased by 25 cm3 (p = 0.005), and LV end-systolic volume decreased by 21 cm3 (p = 0.01). Significant functional improvement differences were also noted between the Carillon group and the GDMT group including an improvement of Kansas City Cardiomyopathy Questionnaire score (15 ± 4 vs. 6 ± 6; p = 0.03). The incidence of HFH was 29.9% versus 50.0% and the cumulative rate of HFH was 0.43 versus 0.75 (p < 0.001).

Conclusions: In patients with functional MR and severe LV enlargement, the Carillon device improved mitral valve function, LV morphology, and functional outcome compared with patients receiving GDMT only. Preoperative LV dimension should not be a limiting factor when evaluating patient eligibility or anticipated response to therapy with the Carillon device.

Keywords: Carillon; congestive heart failure; functional mitral regurgitation; indirect annuloplasty; left ventricular enlargement.

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Conflict of interest statement

Funding Support and Author Disclosures The trial was sponsored by Cardiac Dimensions (Kirkland, Washington). Dr. Anker has received grants and personal fees from Vifor and Abbott Vascular; and personal fees from AstraZeneca, Bayer, Brahms, Boehringer Ingelheim, Cardiac Dimensions, Novartis, Occlutech, Servier, and Vifor. Dr. Starling has served on the advisory board for the PARAGLIDE Trial (Novartis) and Cardiac Dimensions; and has conducted sponsored research Corvia. Dr. Filippatos has received lecture fees and/or Committee Member contributions in trials sponsored by Medtronic, Vifor, Servier, Novartis, Bayer, Amgen, and Boehringer Ingelheim. Dr. Butler has received consulting fees from Boehringer Ingelheim, Cardior, CVRx, Foundry, G3 Pharma, Imbria, Impulse Dynamics, Innolife, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis, Novo Nordisk, Relypsa, Roche, Sanofi, Sequana Medical, V-Wave, Vifor, and Cardiac Dimensions. Dr. von Bardeleben has received consultancy and lecture honoraria from Abbott Vascular, Cardiac Dimensions, Edwards Lifesciences, GE Health Systems, and Philips Healthcare. Dr. Lindenfeld has received grant support from AstraZeneca; and consulting income from Abbott Vascular, Edwards Lifesciences, Boston Scientific, RESMED, Relypsa, Boehringer Ingelheim, and V-Wave. Dr. Coats has received honoraria and/or lecture fees from AstraZeneca, Bayer, Menarini, Novartis, Nutricia, Servier, Vifor, Actimed, Cardiac Dimensions, CVRx, Enopace, Faraday, Gore, Impulse Dynamics, Respicardia, Stealth Peptides, V-Wave, Corvia, Arena, and ESN Cleer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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