Techniques innovantes pour un ttt minimal invasif : le cas de la valve mitrale
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1 Techniques innovantes pour un ttt minimal invasif : le cas de la valve mitrale Lyon Cardiothoracic and Vascular Surgery Department Hôpital Louis Pradel LYON France
2 Affiliation/Financial Relationship List of companies > Grant/Research Support Boeringher, Saint Jude Medical, Abbott, Medtronic, Edwards > Consulting Fees/Honoraria Saint Jude Medical, Medtronic, > Major Stock Shareholder/Equity > Royalty Income Delacroix Chevalier > Ownership/Founder > Intellectual Property Rights Landanger > Other Financial Benefit Sorin, Thoratec, Astra Zeneca, Servier
3 Techniques innovantes pour un ttt minimal invasif : - le cas de la valve mitrale
4 A step by step learning curve Procedure Right Thoracotomy Femoral cannulation External clamp Right mini Thoracotomy Video assisted Femoral cannulation External clamp Right mini Thoracotomy Video assisted Femoral cannulation Balloon Occlusion Sternotomy Long shafted instruments Sternotomy Experience
5 Video Assisted Mitral Valve Surgery > 1500 Patients 14 to 92 y
6 Video Assisted Mitral Valve Surgery > 1500 Patients 32 to 146 Kg
7 No limit in Size
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13 After > Pts Cheap, safe and reproducible
14 Right Mini Thoracotomy Byzantine controversy
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16 Circulation. 2013;128: Surgeries / 17surgeons (< 20 cases)
17 Circulation. Circulation. 2013;128: ;128:
18 Circulation. 2013;128: Heart 2010;96:1964e1967.
19 Techniques innovantes pour un ttt minimal invasif : - le cas de la valve mitrale
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23 Reoperation at 1 and 4 years 2% MV Repair 5.5% 20% Clip 24,8%
24 After Everest : Cohorts & Registries?
25 TAVI Clips Partner II SURTAVI 2000 Pts 2500 Pts Partner AB Corevalve US Choice Notion 1057 pts 747 pts 241 pts 280 pts Reshape 800 pts Coapt 500 pts Mitra.fr 288 pts Everest 279 pts Hiride 294 pts
26 Bill GROSS
27 Transcatheter techniques : From Mitraclip to prostheses EMEA EMEA '14 / '13 '15 / '14 '16 / '15 Implants 4,241 5,843 7,005 8,376 38% 20% 20% Open accounts % 19% 8% sept. 08 déc. 08 mars 09 juin 09 sept. 09 déc. 09 mars 10 juin 10 sept. 10 déc. 10 mars 11 juin 11 sept. 11 déc. 11 mars 12 juin 12 sept. 12 déc. 12 mars 13 juin 13 sept. 13 déc. 13 mars 14 juin 14 sept. 14 déc. 14 mars 15 juin 15 sept. 15 déc. 15 mars 16 juin 16 sept. 16 déc. 16
28 Transcatheter techniques : From repair to prostheses
29 Transapical Off Pump MV Repair 2009 : 1 er patient 2013 : CE mark 2014 : 100 Pts 2015 : 300 Pts
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32 265 patients Worldwide Currently selling in 10 markets Consistent QOQ Growth in cases Q14 4Q14 1Q15 2Q15 3Q15
33 INDIRECTE Annuloplasty
34 INDIRECTE Annuloplasty MONARC (Edwards Lifesciences LLC) CARILLON (Cardiac Dimensions Inc) Two anchor design with chronic reshaping (6weeks) by a foreshortening bridge Acute reshaping device acting in P2P3, repositionable, retrievable EVOLUTION trial (72 pts 82% success) AMADEUS trial (113 pts 58 % success ) PTMA (Viacor Inc) Tri lumen catheter, reshapable, possibility of multiple long term adjustment PTOLEMY (31 pts 29 % success )
35 Valtech Cardio CARDIOBAND First in man in 2013
36 Which is surgical? Percutaneous?
37 Surgical MV Repair Percutaneous Mitral Plasty techniques +
38 Percutaneous Transcatheter Mitral Valve Replacement
39 Vue en échographie 3D de la prothèse (face auriculaire) avant l intervention 2 1 1: Anneau de la prothèse 2: Eversion complète d une cusp expliquant la fuite importante
40 Guidage échographique de l implantation de la prothèse Prothèse mitrale Prothèse mitrale Guide
41
42 Vue en échographie 3D de la prothèse mitrale (face auriculaire) en fin d intervention Prothèse fermée Prothèse ouverte
43 Innovation Evaluation? 1) Mitraclip : All pts PHRC Sec MR Prim. MR ercutaneous Mit. V Repair 2) Neochord : Prim. PHRC MR 2015 P2 A2 /P2 with excess T
44 Lille nnes antes Créteil, Le Plessis Robinson, Massy, Bichat Strasbourg Nancy Besançon lermont Ferrand Lyon ordeaux ontpellier HU et Clinique illénaire) ulouse Marseille (La Timone, Saint Joseph)
Alec Vahanian,FESC, FRCP (Edin.) Bichat Hospital University Paris VII, Paris, France
Future Percutaneous Therapies for Mitral Valve Disease (Mitraclip,percutaneous annuloplasty and transcatheter valve implantation) Will they reach the TAVI s success? Alec Vahanian,FESC, FRCP (Edin.) Bichat
Percutaneous Mitral Plasty techniques
Percutaneous Mitral Plasty techniques Jean- François OBADIA Cardiothoracic and Vascular Surgery Department Hôpital Louis Pradel LYON - France OBADIA Jean- François EACTS 2015 Amsterdam Download this presenta0on
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