Percutaneous Treatment of Left Side Cardiac Valves. Societa Italiana

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2 Percutaneous Treatment of Left Side Cardiac Valves Societa Italiana Ferrarotto Hospital ETNA Foundution University of Catania di Cardiologia Invasiva

3 Corrado Tamburino Gian Paolo Ussia ercutaneous reatment of eft Side Cardiac Va yes A Practical Guide for the Interventional Cardiologist Second Edition In collaboration with Davide Capodanno Massimiliano Mule ~ Springer

4 Corrado Tamburino Full Professor of Cardiology, Director of Postgraduate School of Cardiology Chief of Cardiothoracovascular Department Director of Cardiology Division and Interventional Cardiology Ferrarotto Hospital, University of Catania ETNA Foundation, Gian Paolo Ussia lnterventional Cardiology Director Structural Heart Disease Program Cardiology Division, Ferrarotto Hospital In collaboration with Davide Capodanno Professor of Cardiology, Cardiology Division, Ferrarotto Hospital, University of Catania, ETNA Foundation, Massimiliano Mule Heart Failure Unit, Cardiology Division, Ferrarotto Hospital, University of Catania, ETNA Foundation, The Authors thank the "Associazione Cuore e Ricerca" of Catania for the technical and scientitic support in the realization of this volume ISBN DOl / Springer Milan Dordrecht Heidelberg London New York Library of Congress Control Number: Springer-Verlag Italia 2012 ISBN (ebook) This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now koown or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, 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. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein Cover design: Simona Colombo, Milan, Italy Typesetting: Graphostudio, Milan, Italy Printing and binding: Arti Grafiche Nidasio, Assago (MI), Italy Printed in Italy Springer-Verlag Italia S.r.l., Via Decembrio 28, Milan, Italy Springer is part of Springer Science+Business Media (

5 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

6 Preface to the Second Edition At the time of publication ofthis handbook, percutaneous treatment of left side cardiac valves represented just an exciting and promising opportunity. The lack of outcome data at medium and long term, however, required some caution, since there were still too many unknowns related to a minimally invasive treatment of valvular heart disease, including durability of acute results, long-term impact of procedural complications, patient selection and so on. After two years since our first publication, the literature has produced substantial data supporting particularly transcatheter aortic valve implantation, in parallel with a considerable increase of the procedures around the world, as well as operators' experience and procedural success. These data allow now to consider these procedures not only a promise for the future, but a solid reality of our present. Not surprisingly, the enthusiasm for these achievements has prompted the industry to continuously improve their own devices. The scenario has therefore changed dramatically in recent years, necessitating a substantial update of the first edition of this volume. Once again, the goal ofthis practical handbook is to give interventional cardiologists an advanced understanding and the current state of the art of the percutaneous treatment of left side cardiac valves. Catania, April 2012 Corrado Tamburino Gian Paolo U ssia vii

7 Preface to the First Edition 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 hemodynamics, 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 U ssia ix

8 Contents Contributors XV Abbreviations... XIX 1 Anatomy Mitral Valve Anatomy Mitral Leatlets Annulus Papillary Muscles and Chordae Tendineae Aortic Valve Anatomy Annulus Leatl ets Commissures Interleatlet Triangles Sinuses of Valsalva Sinotubular Junction References Mitral Valve Diseases Mitral Stenosis Epidemiology Pathophysiology Diagnosis Noninvasive Diagnosis Invasive Diagnosis Timing of Intervention Percutaneous Therapy l.5.1 Patient Selection l.5.2 Procedure and Technical Aspects l.5.3 Complications xi

9 xii Contents 2.l.5.4 Results Mitral Regurgitation Epidemiology Pathophysiology Degenerative Mitral Regurgitation Secondary or Functional Mitral Regurgitation Diagnosis Noninvasive Diagnosis Invasive Diagnosis Timing ofintervention Percutaneous Therapy Leaflet Repair Indirect Annuloplasty (Trans catheter Coronary Sinus Techniques) Direct Annuloplasty Chamber and Annular Remodeling Transcatheter Mitral Valve Replacement Percutaneous Neochordal Implantation Mitral Regurgitation Post-Cardiac Resynchronization Therapy References Aortic Valve Disease Aortic Stenosis Epidemiology Pathophysiology Diagnosis NoninvasiveDiagnosis Invasive Diagnosis Timing of Interventions Symptomatic Patients Asymptomatic Patients Percutaneous Treatment of Aortic Stenosis Aortic Valvuloplasty Percutaneous Aortic Valve Implantation Edwards-SAPIEN XT Transcatheter Heart Valve Core Valve Revalving System Device Echocardiographic Guidance during TAVI Essential Reading Other Devices Potential Periprocedural Complications Aortic Regurgitation Epidemiology Pathophysiology Diagnosis

10 Contents xiii Noninvasive Diagnosis Invasive Diagnosis Timing ofinterventions Patient Selection Percutaneous Therapy Transcatheter Aortic Valve Implantation for Degenerated Surgical Bioprosthesis Basics of Surgical Biological Devices References Tips and Tricks and Complication Management in Valvular Interventional Cardiology Patient Selection Anatomical Typing Valve and Heart Anatomy Vascular Anatomy Femoral Arteries Iliac Arteries Abdominal Aorta Thoracic Aorta Procedure Vascular Accesses Choosing the Introducer Passing the Aortic Valve Valvuloplasty Percutaneous Heart Valve Delivery and Implantation Check of Implantation Closing the Arterial Breach with Prostar Device Miscellaneous Difficult Navigation of the Delivery Catheter in the Aortic Arch Recovery of Catheter Fragments Balloon Valvuloplasty Trapping Management of Vascular Complications Mitraclip Device and Technique Procedure Reference Transcatheter Valve Treatment: Periprocedural Management Preprocedural Care Postprocedural Management ICU Care

11 xiv Contents 5.2.l.l Laboratory Tests Renal Function and Fluid Balance Vascular Access Rhythm Control Transthoracic Echocardiogram Medical Treatment and Physical Rehabilitation Before Hospital Discharge Medium-term Management (Out of Hospital) References Subject Index

12 Contributors Corrado Tamburino Full Professor of Cardiology, Director of Postgraduate School of Cardiology, Chief of Cardiothoracovascular Department, Director of Cardiology Division and Interventional Cardiology, Ferrarotto Hospital, University of Catania, ETNA Foundation, Gian Paolo Ussia Interventional Cardiology, Director Structural Heart Disease Program, Cardiology Division, Ferrarotto Hospital, Davide Capodanno Professor of Cardiology, Cardiology Division, Ferrarotto Hospital, University of Catania, ETNA Foundation, Massimiliano Mule Heart Failure Unit, Cardiology Division, Ferrarotto Hospital, University of Catania, ETNA Foundation, Ottavio Alfieri Full Professor of Cardiac Surgery, Director Cardiac Surgery, San Raffaele University Hospital, Milan, Italy Patrizia Aruta Postgraduate School of Cardiology, University of Catania, Marco Barbanti Postgraduate School of Cardiology, University of Catania, Giombattista Barrano Postgraduate School of Cardiology, University of Catania, Giovanni Bartoloni Professor of Anatomic Pathology, Postgraduate School of Cardiology, University of Catania, Laura Basile Executive PA, ETNA Foundation, xv

13 xvi Contributors Antonio Maria Calafiore Full Professor of Cardiac Surgery, Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia Valeria Cammalleri Postgraduate School of Cardiology, University of Catania, George Dangas Cardiovascular Research Foundation, New York, USA, Mount Sinai Medical Center, New York, USA Wanda Deste Echocardiographic Laboratory, Division of Cardiology, Ferrarotto Hospital, Ted Feldman Division of Cardiology, Evanston Hospital, University of Illinois, USA Simona Gulino Division of Cardiology, University of Catania, Lorena Iaco Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia Sebastiano Imme Postgraduate School of Cardiology, University of Catania, Alessio La Manna Interventional Cardiology, Director of Cardiac Magnetic Resonance Program, Cardiology Division, Ferrarotto Hospital, Sarah Mangiafico Echocardiography Laboratory, Division of Cardiology, Ferrarotto Hospital, Anna Marchese Postgraduate School of Cardiology, University of Catania, Margherita Ministeri Postgraduate School of Cardiology, University of Catania, Anna Maria Pistritto Postgraduate School of Cardiology, University of Catania, Matteo Scalia Technician of Cardiovascular Pathophysiology, Division of Cardiology, Ferrarotto Hospital, Salvatore Scandura Echocardiography Laboratory, Division of Cardiology, Ferrarotto Hospital,

14 Contributors xvii Marilena Scarabelli Postgraduate School of Cardiology, University of Catania, Carmelo Sgroi Interventional Cardiology, Division of Cardiology, Ferrarotto Hospital,

15 Abbreviations ACC ACT AHA AIV AKT AI-I1AL-2 ALARA AMADEUS AML AR AS ASA ASD ASS AVA AVB BAV bpm BSA CAG CBC CDS CK CL CMR CO PO CRS CRT CT CVRS CW American College of Cardiology activated clotting time American Heart Association anterior interventricular vein acute kidney injury Amplatz Left-l12 (catheter) as low as reasonably allowable Mitral Annuloplasty Device European Study anterior mitral leaflet aortic regurgitation aortic stenosis acetylsalicylic acid atrial septal defect Amplatz Super Stiff aortic valve area atrioventricular block balloon aortic valvuloplasty beats/min body surface area coronary artery graft complete blood count clip delivery system creatine kinase coaptation length cardiac magnetic resonance chronic obstructive pulmonary disease Core Valve Re Valving system cardiac resynchronization therapy computed tomography cardiovascular valve repair system continuous wave xix