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. 2024 Jun 10;6(4):313-320.
doi: 10.24875/RECIC.M24000464. eCollection 2024 Oct-Dec.

[Edge-to-edge therapy in acute mitral regurgitation. Proposal for a management protocol of the Ischemic Heart Disease and Acute Cardiac Care, Interventional Cardiology, and Cardiovascular Imaging Associations of the Spanish Society of Cardiology]

[Article in Spanish]
Ana Viana-Tejedor  1 , Carlos Ferrera  1 , Rodrigo Estévez-Loureiro  2 , Manuel Barreiro-Pérez  2 , Pilar Jiménez Quevedo  1 , Luis Nombela-Franco  1 , Pablo Jorge-Pérez  3 , Isaac Pascual  4   5 , Amparo Martínez Monzonís  6   7 , Ana Belén Cid Álvarez  6   7
Affiliations

[Edge-to-edge therapy in acute mitral regurgitation. Proposal for a management protocol of the Ischemic Heart Disease and Acute Cardiac Care, Interventional Cardiology, and Cardiovascular Imaging Associations of the Spanish Society of Cardiology]

[Article in Spanish]
Ana Viana-Tejedor et al. REC Interv Cardiol. .

Abstract
in English, Spanish

The approach to patients with acute mitral regurgitation poses a therapeutic challenge. These patients have a very high morbidity and mortality rate, thus requiring a multidisciplinary approach. This document presents the position of 3 associations involved in the management of these patients: the Ischemic Heart Disease and Acute Cardiovascular Care Association, the Interventional Cardiology Association, and the Cardiac Imaging Association. The document discusses aspects related to patient selection and care, technical features of the edge-to-edge procedure from both the interventional and imaging unit perspectives, and the outcomes of this process. The results of mitral repair and/or replacement surgery, which is the first-line treatment option to consider in these patients, have not been included as they exceed the scope of the aims of the document.

El tratamiento de los pacientes con insuficiencia mitral aguda supone un reto terapéutico. Estos pacientes tienen una morbimortalidad muy elevada, que requiere un abordaje multidisciplinario. El presente documento recoge el posicionamiento de tres asociaciones implicadas en el tratamiento de estos pacientes: la Asociación de Cardiopatía Isquémica y Cuidados Agudos Cardiovasculares, la Asociación de Cardiología Intervencionista y la Asociación de Imagen Cardiaca. Incluye aspectos relacionados con la selección y los cuidados del paciente, los aspectos técnicos del tratamiento de borde a borde desde el punto de vista intervencionista y de la imagen cardiaca, y los resultados de este proceso. No se han incluido los resultados de la cirugía de reparación o sustitución mitral, que es la primera opción terapéutica a considerar en estos pacientes, por exceder los objetivos del documento.

Keywords: Acute myocardial infarction; Left ventricular ejection fraction; Mitral regurgitation; Papillary muscle rupture; Transcatheter edge-to-edge mitral valve repair.

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Conflict of interest statement

CONFLICTO DE INTERESES: No existe ningún conflicto de intereses.

Figures

Figura 1
Figura 1. Algoritmo de tratamiento para la insuficiencia mitral aguda. BCIAo: balón de contrapulsación intraaórtico; ECG: electrocardiograma; ECMO: oxigenador extracorpóreo de membrana; ETE: ecocardiografía transesofágica; RxTx: radiografía del tórax.
Figura 2
Figura 2. Momento óptimo para el tratamiento de reparación mitral.
Figura 3
Figura 3. Evaluación de la idoneidad para el tratamiento de reparación mitral de borde a borde. DAVI: dispositivo de asistencia ventricular izquierda; ECMO: oxigenador extracorpóreo de membrana; IM: insuficiencia mitral; TEER: tratamiento de reparación percutánea de borde a borde.
Figure 1
Figure 1. Treatment algorithm for acute mitral regurgitation. ECG, electrocardiogram; ECMO, extracorporeal membrane oxygenator; IABP, intra-aortic balloon pump; RxTx, chest X-ray; TEE, transesophageal echocardiography.
Figure 2
Figure 2. Optimal timing of mitral valve repair therapy.
Figure 3
Figure 3. Eligibility assessment for transcatheter edge-to-edge mitral valve repair. ECMO, extracorporeal membrane oxygenator; LVAD, left ventricular assist device; MR, mitral regurgitation; TEER, transcatheter edge-to-edge repair.
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