Percutaneous Treatment of Left Side Cardiac Valves

Transcription

1 Percutaneous Treatment of Left Side Cardiac Valves Ferrarotto Hospital ETNA Foundation

2 Corrado Tamburino Gian Paolo Ussia Percutaneous Treatment of Left Side Cardiac Valves A Practical Guide for the Interventional Cardiologist In collaboration with Davide Capodanno Massimiliano Mulè

3 Corrado Tamburino Full Professor of Cardiology, Director of, Chief Cardiovascular Department, Director Cardiology Division and Interventional Cardiology, Ferrarotto Hospital,, ETNA Foundation, Gian Paolo Ussia Co-Director Interventional Cardiology, Director Structural Heart Disease Program Cardiology Division, Ferrarotto Hospital, In collaboration with Davide Capodanno Research Fellow, Chair of Cardiology Division,, ETNA Foundation, Massimiliano Mulè Research Fellow, Chair of Cardiology Division,, ETNA Foundation, The authors thank the Associazione Cuore e Ricerca of Catania for the technical and scientific support in the realization of this volume ISBN e-isbn DOI / Springer Dordrecht Heidelberg London Milan New York Library of Congress Control Number: Springer-Verlag Italia 2010 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the Italian Copyright Law in its current version, and permission for use must always be obtained from Springer. Violations are liable to prosecution under the Italian Copyright Law. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature Drawings by: Giombattista Barrano Anatomopathologic pictures by: Giovanni Bartoloni Typesetting: Compostudio, Cernusco s/n (Milan), Italy Printing and binding: Arti Grafiche Nidasio, Assago (Milan), Italy Printed in Italy Springer-Verlag Italia S.r.l, Via Decembrio 28, I Milan, Italy Springer is part of Springer Science+Business Media (

4 This volume is dedicated to the real engine of research, motivating force of passion and mental vivacity: my students, young doctors and fellows to whom I wish to say a sincere thank you Corrado Tamburino

5 Preface Transcatheter therapy of cardiac valve diseases is a rediscovery by interventional cardiologists. Treating cardiac valve diseases with alternative techniques to cardiac surgery using prosthetic devices has rekindled interest in the field of hemo-dynamics, which has been neglected in recent years. Within this framework, two sectors can be distinguished: valvuloplasty techniques using a balloon alone to treat mitral, aortic, and pulmonary stenoses, and those using prosthetic heart valves or repair devices. Valvuloplasty techniques should be considered as palliative, as the duration of their effectiveness varies from just a few weeks, as in the case of aortic valvuloplasty for degenerative stenoses, to years, as in the case of mitral and pulmonary valvuloplasty. By contrast, transcatheter implantation of biological prosthetic valves, or repair techniques using dedicated devices aim to provide a definitive therapeutic solution or at least a solution offering results that are equal to or just as good as those of cardiac surgery. The advent of devices for the percutaneous treatment of left chamber valve diseases is one of the greatest breakthroughs in interventional cardiology. The goal of this handbook is to give interventional cardiologists the means to understand the context of the percutaneous treatment of valve diseases and the state of the art of the techniques and procedures currently available. Catania, April 2010 Corrado Tamburino Gian Paolo Ussia VII

6 Contents 1 Anatomy 1.1 Mitral Valve Anatomy Mitral Leaflets and the Dynamics of Their Movement The Annulus The Chordae Tendineae and Papillary Muscles Aortic Valve Anatomy The Annulus The Leaflets The Commissures The Interleaflet Triangles The Sinuses of Valsalva The Sinotubular Junction References Mitral Valve Disease 2.1 Mitral Stenosis The Pathophysiology of Mitral Stenosis Diagnosis Non-invasive Diagnosis Invasive Diagnosis Timing of Interventions Patient Selection Percutaneous Therapy Procedure and Technical Aspects Mitral Valvuloplasty Outcomes Complications Mitral Regurgitation The Pathophysiology of Mitral Regurgitation Physiopathology Diagnosis Non-invasive Diagnosis IX

7 X Contents Invasive Diagnosis Timing of Interventions Patient Selection Anatomical and Functional Assessment of the Mitral Valve Assessment of Regurgitation Etiopathogenesis Selection of Patients for Implantation Percutaneous Therapy Leaflets Repair Transcatheter Coronary Sinus Techniques Annuloplasty Techniques Chamber and Annular Remodeling A Glimpse into the Future References Aortic Valve Disease 3.1 Aortic Stenosis The Pathophysiology of Aortic Stenosis Diagnosis Non-invasive Diagnosis Invasive Diagnosis Timing of Interventions Symptomatic Patients Asymptomatic Patients Patient Selection Valve Annulus Sinuses of Valsalva (Width and Height) Sinotubular Junction (STJ) Left Ventricular Outflow Tract Ascending Aorta Iliac-femoral Axis and Subclavian Artery Percutaneous Therapy Edwards-SAPIEN Valve CoreValve ReValving System Other Devices Procedural Complications Aortic Regurgitation The Pathophysiology of Aortic Regurgitation Diagnosis Non-invasive Diagnosis Invasive Diagnosis Timing of Interventions Patient Selection

8 Contents XI Percutaneous Therapy References Tips and Tricks and Management of Complications in Valvular Interventional Cardiology 4.1 Patient Selection and Work-up Anatomical Typing Valve and Heart Anatomy Vascular Anatomy Femoral Arteries Iliac Arteries Abdominal Aorta Thoracic Aorta Procedure Vascular Access Choosing the Introducer Passing the Aortic Valve Valvuloplasty CoreValve Revalving System Delivery and Implantation Check on Implantation Closing the Arterial Breach with the Prostar Device Miscellaneous Difficult Navigation of the Delivery Catheter in the Aortic Arch Recovery of Catheter Fragments Balloon Valvuloplasty Trapping Cardiac Perforation Introducer Replacement The MitraClip Device and Technique Procedure Reference Transcatheter Valve Treatment: Peri-procedural Management 5.1 Pre-procedural Care Post-procedural Management ICU Care Laboratory Tests Renal Function and Fluid Balance Vascular Access Rhythm Control

9 XII Contents Transthoracic Echocardiogram Medical Treatment and Physical Rehabilitation Before Hospital Discharge Medium-term Management (Out of Hospital) References Surgical Treatment of Mitral Regurgitation and Aortic Stenosis 6.1 Treatment of Degenerative Mitral Regurgitation Epidemiology and Natural History Diagnosis and Quantification of Degenerative Mitral Regurgitation Surgical Considerations Types of Procedure Surgical Indications Principles of Mitral Repair Surgery Results Treatment of Functional Mitral Regurgitation Treatment of Aortic Stenosis Surgical Indications Specific Issues Mechanical or Tissue Valves Prosthesis Patient Mismatch The Role of Transfemoral or Transapical Aortic Valve Replacement References

10 List of Authors and Contributors Corrado Tamburino Full Professor of Cardiology Director of Postgraduate School of Cardiology Chief of Cardiovascular Department Director of Cardiology Division and Interventional Cardiology Ferrarotto Hospital ETNA Foundation Gian Paolo Ussia Co-Director of Interventional Cardiology Director Structural Heart Disease Program Cardiology Division Ferrarotto Hospital Davide Capodanno Research Fellow Chair of Cardiology Division ETNA Foundation Massimiliano Mulè Research Fellow Chair of Cardiology Division ETNA Foundation Ottavio Alfieri Full Professor of Cardiac Surgery Director Cardiac Surgery San Raffaele University Hospital Milan, Italy Antonio Maria Calafiore Full Professor of Cardiac Surgery Department of Adult Cardiac Surgery Prince Sultan Cardiac Center Riyadh, Saudi Arabia XIII

11 XIV List of Authors and Contributors George Dangas Cardiovascular Research Foundation New York, USA Cardiology Department Onassis Cardiac Surgery Centre Athens, Greece Ted Feldman Division of Cardiology Evanston Hospital University of Illinois, US Patrizia Aruta Marco Barbanti Gionbattista Barrano Giovanni Bartoloni Professor of Anatomic Pathology Michele De Bonis Cardiac Surgery San Raffaele Hospital Milan, Italy Valeria Cammalleri Wanda Deste Echocardiography Laboratory Division of Cardiology Ferrarotto Hospital Lorena Iacò Department of Adult Cardiac Surgery Prince Sultan Cardiac Center Riyadh, Saudi Arabia Sebastiano Immè Sarah Mangiafico Echocardiography Laboratory Division of Cardiology Ferrarotto Hospital Anna Marchese Anna Maria Pistritto Salvatore Scandura Director of Echocardiography Laboratory Division of Cardiology Ferrarotto Hospital Marilena Scarabelli

12 List of Authors and Contributors XV Konstantinos Spargias Cardiology Department Onassis Cardiac Surgery Centre Athens, Greece Maurizio Taramasso Cardiac Surgery San Raffaele Hospital Milan, Italy Adel Tash Department of Adult Cardiac Surgery Prince Sultan Cardiac Center Riyadh, Saudi Arabia Laura Basile Executive PA ETNA Foundation

13 Abbreviations ACC ACE ACT AHA AIV AL-1/AL-2 AMADEUS AR AS ASA ASD ASS AVA AVB AVR bpm CABG CC CD CDS CI CIMR CIN CK CL CRS CT CVRS CW American College of Cardiology angiotensin-converting enzyme activated clotting time American Heart Association anterior atrioventricular vein Amplatz Left-1/2 (catheter) Mitral Annuloplasty Device European Study aortic regurgitation aortic stenosis acetylsalicylic acid atrial septal defect Amplatz Super Stiff (guidewire) aortic valve area atrioventricular block aortic valve replacement beats/min coronary artery bypass grafting intercommisural distance coaptation distance clip delivery system confidence interval chronic ischemic mitral regurgitation contrast-induced nephropathy creatine kinase coaptation length CoreValve ReValving System computed tomography cardiovascular valve repair system continuous wave (Doppler) XVII

14 XVIII Abbreviations CWP capillary wedge pressure 2D two-dimensional 3D three-dimensional DCS delivery catheter system DT deceleration E-time ECG electrocardiogram ECMO extracorporeal membrane oxygenation EF ejection fraction EOA effective orifice area ERO effective regurgitant orifice EROA effective regurgitant orifice area ES Edwards-SAPIEN (heart valve) ESC European Society of Cardiology EuroSCORE European System for Cardiac Operative Risk Evaluation EVEREST Endovascular Edge-to-edge Repair Study Trial EVOLUTION EValuation Of the Edwards Lifesciences percutaneous mitral annuloplasty system for the treatment of mitral regurgitation FH Ferrarotto Hospital (Catania) FIM First In Man (study) FMR functional mitral regurgitation FSV forward stroke volume HIT heparin-induced thrombocytopenia IAS inter-atrial septum ICU intensive care unit IMR ischemic mitral regurgitation INR international normalized ratio JR Judkins catheter IV intravenous LA left atrium LAA left atrial appendage LAP left atrial pressure LBBB left bundle branch block LDH lactic dehydrogenase LIMA left internal mammary artery LMCA left main coronary artery LMWH low molecular weight heparin LV left ventricle LVDP left ventricular diastolic pressure LVEDP left ventricular end-diastolic pressure LVEF left ventricle ejection fraction LVESD left ventricular end-systolic diameter LVESV left ventricular end-systolic volume LVESVI left ventricular end-systolic volume index

15 Abbreviations XIX LVOT MACCE MAE MI ML MP MR MRI MSCT MVA NHLBI NYHA OR OS PAP PCWP PHT PISA PMC PMV PPM PTMA PTOLEMY PVF PW RBBB RF RR RV S 1 S 2 S 3 SAM SGC SL SLE spap SRH STJ STS STS-PROM TA TAVI left ventricular outflow tract major adverse cardiac and cerebrovascular event major adverse event myocardial infarction mid-lateral multipurpose catheter mitral regurgitation magnetic resonance imaging multislice computed tomography mitral valve area National Heart, Lung, and Blood Institute New York Heart Association odds ratio opening snap pulmonary artery pressure pulmonary capillary wedge pressure pressure half-time proximal isovelocity surface area percutaneous mitral commisurotomy percutaneous mitral valvulotomy prosthesis patient mismatch percutaneous transvenous mitral annuloplasty Percutaneous Mitral Annuloplasty (trial) pulmonary venous flow pulsed wave (Doppler) right bundle branch block regurgitant fraction risk ratio regurgitant volume first heart sound second heart sound third heart sound systolic anterior motion steerable guide catheter septal lateral distance systemic lupus erythematosus systolic pulmonary artery pressure San Raffaele Hospital (Milan) sinotubular junction Society of Thoracic Surgeons STS Predicted Risk of Mortality tenting area transcatheter aortic valve implantation

16 XX Abbreviations TEE TIA TSV TTE UFH UGCR VC VKA transesophageal echocardiogram/echocardiography transient ischemic attack total stroke volume transthoracic echocardiogram/echocardiography unfractionated heparin ultrasound-guided compression repair vena contracta vitamin K antagonist