Interventional Diagnosis And Treatment of Valvular Heart Disease

Size: px
Start display at page:

Download "Interventional Diagnosis And Treatment of Valvular Heart Disease"

Transcription

1 Interventional Diagnosis And Treatment of Valvular Heart Disease Peter S. Fail, MD, FACC, FACP, FSCAI Director of the Cardiac Catheterization Laboratories And Interventional Research Co-Director of the Structural Heart Program Cardiovascular Institute of the South Terrebonne General Medical Center Houma, LA

2 Peter S. Fail, MD FACC, FACC, FSCAI Disclosure Statement of Financial Interest Grant Research Support Stock Abbott Vascular Medtronic CardioKinetix Boston Scientific Covina Direct Flow Medical (Steering Committee ) CardioSolutions Off label use of products and investigational devices will be discussed in this presentation

3 Structural Heart Arena Over the past 10 years the area of structural heart has virtually exploded Many of the areas that have been the exclusive domain of Cardiovascular surgery are now being evaluated treated by the Heart Team Many newer devices and ideas are being put forth each day Only time will tell which treatment strategy will survive

4 Aortic Stenosis

5 Incidence and Prevalence Aortic stenosis is the most common acquired valvular disorder found in developed countries Affects approximately 5 out of every 10,000 people in the United States Mild to severe AS present in up to 9% of adults over age 65 years The prevalence of calcific aortic stenosis increases with age and is expected to double in the next 20 years* Freeman RV, Otto CM. Spectrum of Calcific Aortic Valve Disease: Pathogenesis, Disease Progression, and Treatment Strategies. Circulation 2005;111: *Nkomo VT, et al. Lancet 2006;368:

6 % Survival Symptomatic Patients with Severe AS Require Urgent Attention Valvular Aortic Stenosis In Adults (Average Course) Latent Period Increasing Obstruction Myocardial Overload Onset Severe Symptoms - Angina -Syncope -CHF Age in Years Ross J Jr, Braunwald E. Aortic stenosis. Circulation 1968;38 (Suppl 1) C.M. Otto. Valve Disease: Timing of Aortic Valve Surgery. Heart 2000 Surgical intervention should be performed promptly even once minor symptoms occur.

7 Assessing Futility Is Not Frailty Alone Co-Morbidities STS - Euroscore Charlson Score Two or more medical conditions Frailty Impairment in multiple systems that leads to a decline in homeostatic reserve and resiliency Disability: ADL IADLs Difficulty or dependency in daily living

8 CoreValve US Extreme Risk Baseline Co-Morbidities Co-Morbidity Assessment N=471 Any Chronic Lung Disease (STS Criteria), % 58.8 Moderate, % 15.3 Severe*, % 24.0 Home Oxygen, % 30.4 FEV cc, % 23.1 Diffusion Capacity < 50%, % 22.3 Charlson Co-Morbidity Score**, % 5.3 ± 2.3 Moderate (3, 4), % 32.9 Frailty Severe Characteristic (> 5), % N= Anemia With Prior Transfusion, % 22.9 BMI < 21 kg/m 2, % 7.6 Albumin < 3.3 g/dl, % 18.5 Unplanned Weight Loss > 10 pounds, % 16.9 *STS Criteria: Severe = FEV1 < 50% predicted and/or RA po 2 < 60 or pco 2 > 50 BAD LUNGS Charlson Score: = 1 MI, CHF, PVD, CVD, Dementia, chronic lung disease, connective tissue disease, ulcer disease, mild liver disease, DM; =2 BAD hemiplegia, BODY mod-severe kidney disease, diabetes with end organ damage, leukemia, lymphoma; = 3 moderate or severe liver disease; = 6 metastatic solid tumor, AIDS BAD EVERYTHING ELSE Falls in Past 6 Months, % Meter Gait Speed > 6 secs, % 84.2 Grip Strength < Threshold, % 67.6 **Charlson Score: = 1 MI, CHF, PVD, CVD, dementia, chronic lung disease, connective tissue disease, ulcer, mild liver disease, DM; = 2 hemiplegia, modsevere kidney disease, diabetes with end organ damage, leukemia, lymphoma; = 3 moderate or severe liver disease; = 6 metastatic solid tumor, AIDS Extreme Risk Study Iliofemoral Pivotal

9 Where it all started April 16th, 2002 Alain Cribier April 16 th 2002 Implanted the worlds first Percutaneous Aortic Valve

10 Approved Devices CoreValve Aortic Annulus Range 1 CT mm Sapien XT Aortic Annulus Range 2 TEE CT mm mm 1. Medtronic CoreValve System Instructions for Use. M053136T001 Rev. 1C. 06/ Edwards SAPIEN XT Transcatheter Heart Valve with the NovaFlex+ Delivery System Instructions for Use D. 06/2014.

11 Current Generation of Approved Stent Valves S3

12 All-Cause Mortality NOTE: The charts are not intended to be a comparison of the two devices as there is no head-to-head clinical study, but rather are intended to illustrate the clinical results of two similar trials. Multiple factors contribute to clinical study outcomes and need to be considered in making any assessments across different studies.

13 Major Stroke NOTE: The charts are not intended to be a comparison of the two devices as there is no head-to-head clinical study, but rather are intended to illustrate the clinical results of two similar trials. Multiple factors contribute to clinical study outcomes and need to be considered in making any assessments across different studies.

14 Aortic Valve Area NOTE: The charts are not intended to be a comparison of the two devices as there is no head-to-head clinical study, but rather are intended to illustrate the clinical results of two similar trials. Multiple factors contribute to clinical study outcomes and need to be considered in making any assessments across different studies.

15 Mean Gradient NOTE: The charts are not intended to be a comparison of the two devices as there is no head-to-head clinical study, but rather are intended to illustrate the clinical results of two similar trials. Multiple factors contribute to clinical study outcomes and need to be considered in making any assessments across different studies.

16 84 yo F STS 11, FEV1 38% predicted (0.790 L) Critical AS (AVA 0.5cm2, 64mmHg Gradient) Severe PVD densely calcified Iliacs

17 So Many Options that are on the Horizon

18 Repositionable Mechanical Expansion No Metal Components

19 Newer indications Valve -in- Valve Aortic Insufficiency

20 Lower Risk Patients Reported at the ACC 2016 Vinod Thourani, MD PARTNERS 2A Mortality (7.4% for TAVR versus 13.0% for surgery, P<0.001 for superiority) Stroke (4.6% versus 8.2%, P=0.004 for superiority). Moderate or severe aortic regurgitation, favored surgery (1.2% versus 1.5% for TAVR, P= for superiority). Medtronic SURTavi (intermediate risk) Completed enrollment Data will be available 2017 ACC??? Both companies are engaged in Low Risk Trail

21 Mitral Regurgitation

22 Bulging Mechanisms Mitral Regurgitation Degenerative Functional Redundant / Broken Chordea Sick Valve Papillary muscle traction Sick Heart Increased tethering Flail or Degenerative Leaflets Decreased closing force MR MR Annular dilatation

23 Re-operation rate vs. MR reoccurrence Degenerative Valve Disease N Surgical Technique Reoperation rate % at latest follow-up (y) % MR 3+ at latest follow-up (Y) Author Gillinov, et al. Ann Thor Surg, Carpentier* 5% (5 y) 9% (1.5 y) Tanaka, et al. Am J Cardiol, Carpentier* 5.3 (3.7 y) 7% (3.5 y) Flameng, et al. Circulation, Carpentier* 5.8 (7 y) 29% (7 y) * Standard repair with annuloplasty in vast majority

24 Durability of Ischemic Mitral Valve Repair? 78 patients with IMR treated with Mitral Valve Repair Long follow-up 94% success rate in obtaining long-term ECHO Results at mean of 28 months: Recurrent MR (2+) in 37% of patients Severe MR (3 to 4+) in 20% of patients Serri et al. JTCVS 131: , 2006

25 Original Article Two-Year Outcomes of Surgical Treatment of Severe Ischemic Mitral Regurgitation Daniel Goldstein, M.D., Alan J. Moskowitz, M.D., Annetine C. Gelijns, Ph.D., Gorav Ailawadi, M.D., Michael K. Parides, Ph.D., Louis P. Perrault, M.D., Judy W. Hung, M.D., Pierre Voisine, M.D., Francois Dagenais, M.D., A. Marc Gillinov, M.D., Vinod Thourani, M.D., Michael Argenziano, M.D., James S. Gammie, M.D., Michael Mack, M.D., Philippe Demers, M.D., Pavan Atluri, M.D., Eric A. Rose, M.D., Karen O Sullivan, M.P.H., Deborah L. Williams, B.S.N., M.P.H., Emilia Bagiella, Ph.D., Robert E. Michler, M.D., Richard D. Weisel, M.D., Marissa A. Miller, D.V.M., Nancy L. Geller, Ph.D., Wendy C. Taddei-Peters, Ph.D., Peter K. Smith, M.D., Ellen Moquete, R.N., Jessica R. Overbey, M.S., Irving L. Kron, M.D., Patrick T. O Gara, M.D., Michael A. Acker, M.D., for the CTSN N Engl J Med Volume 374(4): January 28, 2016

26 OUTCOMES AT 2 YEARS Outcome Repair Replacement p Value LVESVI ml/m ml/m2 Mortality 19% 23% 0.42 Moderate/Severe MR 59% 3.8% < SAE with Heart Failure 24% 15% 0.05 Cardiac Readmits 48% 32% 0.01 LVESVI ml/m cc/m Ejection Fraction 43% 38%

27 Functional MR vs Organic Valve Disease ~ 1,100,000 patients/yr with US 1 85% with dilated Cardiomyopathy = 950,000/yr 65% with MR = ~620,000 with FMR in US 40% with more then mild MR = ~380,000/yr VERSUS 38,000 discharges with Mitral Valve Disease/yr 2 48,000 discharges with Aortic Valve Disease/yr 2 <50,000 Aortic or Mitral Surgeries (2005) 3 1 Roger JAMA 2004;292:344 2 AHA Heart Disease and Stroke 2008 update 3 Barnett J Thoracic Cardiovasc Surg 2009

28

29 2 Different etiologies of MR

30 PRE CLIP POST CLIP

31

32 FDA MitraClip Approval October 24 th, 2013 The MitraClip is approved for treatment of patients with primary (degenerative) MR who are at prohibitive risk for mitral valve surgery and are likely to benefit from MR reduction

33 Kaplan-Meier Freedom From Mortality EVEREST II RCT MitraClip (N=178) 93.7% 92.3% 1 year Surgery (N=80) 81.2% 79.0% 5 years Baseline 6 Months 12 Months 18 Months 2 Years 3 Years 4 Years 5 Years MitraClip # At Risk Surgery # At Risk

34 Kaplan-Meier Freedom From MV Surgery in MitraClip Group or Re-operation in Surgery Group Surgery (N=80) MitraClip (N=178) 78.9% 97.4% 1 year 74.3% 92.5% 5 years Baseline 6 Months 12 Months 18 Months 2 Years 3 Years 4 Years 5 Years MitraClip # At Risk Surgery # At Risk EVEREST II RCT Deaths are censored

35 Kaplan-Meier Freedom From MV Surgery in MitraClip Group or Re-operation in Surgery Group Surgery MitraClip 97.1% 98.7% 1 year 91.4% 93.7% 5 years 6-Month Landmark Analysis EVEREST II RCT

36 Transcatheter MV Repair: Device Landscape 2016 Edge-to-edge MitraClip* MitraFlex Direct annuloplasty and basal ventriculoplasty Mitralign Bident* GDS Accucinch* Valtech Cardioband* Quantum Cor (RF) Micardia encor *In patients Coronary sinus annuloplasty Cardiac Dimensions Carillon* Cerclage annuloplasty MV replacement CardiAQ* Neovasc * Edwards Fortis* Micro Interventional Valtech Cardiovalve ValveXchange Lutter Valve Medtronic Tendyne* MitrAssist MValve Other approaches MitraSpacer* St. Jude leaflet plication* Cardiac Implant perc ring NeoChord* Babic chords Valtech Vchordal Middle Peak Medical Mardil BACE Mitralis Millipede

37 Mitral Annuloplasty Systems Under current development Cardiac Dimensions Carillon Indirect annuloplasty Coronary sinus cinching Mitralign TAMR GDS Accucinch Valtech Cardioband - Trans-aortic - LV implant of 1-3 annular pairs of pledgets - Basal ventriculoplasty - LV implant of anchors - Trans-septal - LA implant of a posterior annulus band (screw fixation)

38 Transcatheter MV Replacement Devices with Human Implants CardiAQ 2 chronic implants Edwards Fortis 5 chronic implants Neovasc Tiara 2 chronic implants Tendyne 2 acute implants before surgery

39 Transcatheter MV Replacement Edwards Fortis Neovasc Tiara CardiAQ Tendyne Micro Interventional Valtech Cardiovalve ValveXchange Lutter Valve Medtronic MitrAssist MValve Challenges

40 Off Label 74 yo female with critical Mitral Stenosis Cosgrove ring for MR 10 years ago Prohibitive surgical risk

41 TAVR vs. TMVR Annulus Size and Calcifications Leaflet Calcification Annulus Size, Shape, excursion, Leaflet Size, Thickness, Tenting Sub-valvular Apparatus Circumflex Coronary Artery LV Size, Geometry, Function Risk of SAM and Out Flow obstruction Dynamic Environment

42 Conclusion Valvular Heart Disease Intervention has exploded over the past Decade. Multiple devices and procedures continues to be available Alternative indications are currently being explored TAVR has been the driving force in the structural heart world, but mitral will separate the men from the boys Next 10 years will be incredibly exciting

43 Interventional Diagnosis And Treatment of Valvular Heart Disease Peter S. Fail, MD, FACC, FACP, FSCAI Director of the Cardiac Catheterization Laboratories And Interventional Research Co-Director of the Structural Heart Program Cardiovascular Institute of the South Terrebonne General Medical Center Houma, LA

Percutaneous mitral valve repair therapy in organic mitral regurgitation. Francesco Maisano MD San Raffaele Hospital Milano, Italy

Percutaneous mitral valve repair therapy in organic mitral regurgitation. Francesco Maisano MD San Raffaele Hospital Milano, Italy Percutaneous mitral valve repair therapy in organic mitral regurgitation Francesco Maisano MD San Raffaele Hospital Milano, Italy Conflict of interest statement Francesco Maisano is Consultant for Abbott

More information

Percutaneous mitral valve repair: leaflet & annuloplasty approaches. Ted Feldman, M.D., FSCAI

Percutaneous mitral valve repair: leaflet & annuloplasty approaches. Ted Feldman, M.D., FSCAI Percutaneous mitral valve repair: leaflet & annuloplasty approaches Ted Feldman, M.D., FSCAI Ted Feldman MD, FACC, FSCAI Disclosure Information The following relationships exist: Grant support: Abbott,

More information

Update on a Tethered Transapical Device for TMVR Vinay Badhwar, MD

Update on a Tethered Transapical Device for TMVR Vinay Badhwar, MD Update on a Tethered Transapical Device for TMVR Vinay Badhwar, MD Gordon F. Murray Professor and Chairman Department of Cardiovascular & Thoracic Surgery WVU Heart and Vascular Institute West Virginia

More information

2017 Update to the AHA/ACC Guideline for Management of Mitral Valve Disease

2017 Update to the AHA/ACC Guideline for Management of Mitral Valve Disease 2017 Update to the AHA/ACC Guideline for Management of Mitral Valve Disease Patrick T. O Gara, MD BWH Heart and Vascular Center Professor of Medicine, Harvard Medical School Disclosures NHLBI CTSN Co-chair

More information

Igor Palacios, MD Director of Interventional Cardiology Massachusetts General Hospital Professor of Medicine Harvard Medical School

Igor Palacios, MD Director of Interventional Cardiology Massachusetts General Hospital Professor of Medicine Harvard Medical School Aortic Stenosis: Current State of Percutaneous Therapies, Emerging Technologies and Future Directions Igor Palacios, MD Director of Interventional Cardiology Massachusetts General Hospital Professor of

More information

Catheter-based mitral valve repair MitraClip System

Catheter-based mitral valve repair MitraClip System Percutaneous Mitral Valve Repair: Results of the EVEREST II Trial William A. Gray MD Director of Endovascular Services Associate Professor of Clinical Medicine Columbia University Medical Center The Cardiovascular

More information

Self-Expanding versus Balloon- Expandable Device Implant - When and How to Choose?

Self-Expanding versus Balloon- Expandable Device Implant - When and How to Choose? Self-Expanding versus Balloon- Expandable Device Implant - When and How to Choose? Gerald Yong MBBS (Hons) FRACP FSCAI Interventional Cardiologist Royal Perth Hospital Western Australia APCASH 11 Oct 2014

More information

Debate: SAVR for Low-Risk Patients in 2017 is Obsolete AVR vs TAVI

Debate: SAVR for Low-Risk Patients in 2017 is Obsolete AVR vs TAVI Debate: SAVR for Low-Risk Patients in 2017 is Obsolete AVR vs TAVI Joseph E. Bavaria, MD Roberts-Measey Professor of Surgery Vice Chair, Division of Cardiovascular Surgery University of Pennsylvania Immediate

More information

Transcatheter Options for MR

Transcatheter Options for MR Transcatheter Options for MR Howard C. Herrmann, MD, FACC, MSCAI John Bryfogle Professor of Cardiovascular Medicine and Surgery Health System Director for Interventional Cardiology Director, Cardiac Cath

More information

AN INTRODUCTION TO TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR)

AN INTRODUCTION TO TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) AN INTRODUCTION TO TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) ERNESTO RUIZ-RODRIGUEZ, MD, FACC INTERVENTIONAL & STRUCTURAL CARDIOLOGY 1 TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) ERNESTO RUIZ-RODRIGUEZ,

More information

Aortic Stenosis: Background

Aortic Stenosis: Background Transcatheter Aortic Valve Replacement in Low Surgical Risk Patients Barry George, MD The Ohio State University Structural Heart Disease Course May 19 th, 2017 Aortic Stenosis: Background Severe Symptomatic

More information

TAVR today: High Risk, Intermediate Risk Population, and Valve in Valve Therapy

TAVR today: High Risk, Intermediate Risk Population, and Valve in Valve Therapy TAVR today: High Risk, Intermediate Risk Population, and Valve in Valve Therapy Alan Zajarias, MD FACC Structural Interventional Fellowship Director Associate Professor Medicine Cardiovascular Division

More information

TAVR. Indications, Techniques, Outcomes and Results

TAVR. Indications, Techniques, Outcomes and Results TAVR Indications, Techniques, Outcomes and Results Charles H. Wyatt, M.D. Dept of Thoracic and Cardiovascular Surgery The Heart Institute at The Regional Medical Center of Acadiana What Causes Aortic Stenosis

More information

Tricuspid Regurgitation

Tricuspid Regurgitation Tricuspid Regurgitation Steven J. Lester MD, FACC, FRCP(C), FASE Relevant Financial Relationship(s) None Off Label Usage None 1. To develop a more rich understanding of the anatomy of the tricuspid valve.

More information

Transcatheter Echo Guided Mitral Valve Repair with NeoChord Implantation: Results from NeoChord Independent International Registry

Transcatheter Echo Guided Mitral Valve Repair with NeoChord Implantation: Results from NeoChord Independent International Registry Transcatheter Echo Guided Mitral Valve Repair with NeoChord Implantation: Results from NeoChord Independent International Registry A. Colli, E. Bizzotto, E. Manzan, L. Besola, F. Zucchetta, D.Pittarello,

More information

You re Still Using That?!?

You re Still Using That?!? You re Still Using That?!? Look What I am Doing. TAVI in Europe Hendrik Treede, MD University Heart Center Hamburg, Germany Potential conflicts of interest Speaker s name Hendrik Treede, MD X I have the

More information

Treatment of severe tricuspid regurgitation: the surgeon's point of view

Treatment of severe tricuspid regurgitation: the surgeon's point of view Treatment of severe tricuspid regurgitation: the surgeon's point of view Mauro Rinaldi MD SC Cardiochirurgia U Universita degli Studi di Torino Direttore: Prof. M. Rinaldi Introduction Right-sided cardiac

More information

SAPIEN 3: Evaluation of a Balloon- Expandable Transcatheter Aortic Valve in High-Risk and Inoperable Patients With Aortic Stenosis One-Year Outcomes

SAPIEN 3: Evaluation of a Balloon- Expandable Transcatheter Aortic Valve in High-Risk and Inoperable Patients With Aortic Stenosis One-Year Outcomes SAPIEN 3: Evaluation of a Balloon- Expandable Transcatheter Aortic Valve in High-Risk and Inoperable Patients With Aortic Stenosis One-Year Outcomes Howard C. Herrmann, MD on behalf of The PARTNER II Trial

More information

Transcatheter Aortic Valve Replacement (TAVR) & Trends in CV Anesthesia. Dr Sharif Al-Ruzzeh MD, PhD, FASE, FRCS, FRCSEd Cardiac Anesthesiologist

Transcatheter Aortic Valve Replacement (TAVR) & Trends in CV Anesthesia. Dr Sharif Al-Ruzzeh MD, PhD, FASE, FRCS, FRCSEd Cardiac Anesthesiologist Transcatheter Aortic Valve Replacement (TAVR) & Trends in CV Anesthesia Dr Sharif Al-Ruzzeh MD, PhD, FASE, FRCS, FRCSEd Cardiac Anesthesiologist NO DISCLOSURES Prevalence of Aortic Stenosis Aortic stenosis

More information

Two-Year Outcomes of Surgical Treatment of Severe Ischemic Mitral Regurgitation

Two-Year Outcomes of Surgical Treatment of Severe Ischemic Mitral Regurgitation The new england journal of medicine Original Article Two-Year Outcomes of Surgical Treatment of Severe Ischemic Mitral Regurgitation D. Goldstein, A.J. Moskowitz, A.C. Gelijns, G. Ailawadi, M.K. Parides,

More information

Update on the Treatment of Aortic Stenosis Focus on TAVR

Update on the Treatment of Aortic Stenosis Focus on TAVR Update on the Treatment of Aortic Stenosis Focus on TAVR RIACC Primary Care Symposium October 2 nd, 2013 Barry Sharaf, M.D. Interim Director RIH Cardiac Catheterization Laboratory Associate Professor Brown

More information

Degenerative Mitral Valve Regurgitation: Resect or Respect?

Degenerative Mitral Valve Regurgitation: Resect or Respect? Degenerative Mitral Valve Regurgitation: Resect or Respect? Juan P. Umaña, M.D. Chief Medical Officer Director, Cardiovascular Medicine FCI - Institute of Cardiology Bogota Colombia The Myxomatous Mitral

More information

Edwards Balloon Expandable Valve Updated techniques and current indication

Edwards Balloon Expandable Valve Updated techniques and current indication Edwards Balloon Expandable Valve Updated techniques and current indication TAVI Summit, Seoul, Korea, Spetember 2 nd, 2011 Alain Cribier, MD University Hospital Charles Nicolle Rouen, France Edwards Lifesciences

More information

TRANSCATHETER HEART VALVE PROCEDURES

TRANSCATHETER HEART VALVE PROCEDURES UnitedHealthcare Commercial Medical Policy TRANSCATHETER HEART VALVE PROCEDURES Policy Number: 2017T0557M Effective Date: November 1, 2017 Table of Contents Page INSTRUCTIONS FOR USE... 1 BENEFIT CONSIDERATIONS...

More information

Mitral Regurgitation:

Mitral Regurgitation: Mitral Regurgitation: Emerging Concepts Elyse Foster, MD Professor of Medicine Disclosure: Grants from Evalve,, Inc Guidant - Boston Scientific Corporation Classification of Mitral regurgitation: Organic

More information

DISCLOSURE. I have N O relevant financial relationships

DISCLOSURE. I have N O relevant financial relationships Percutaneous MV Repair Steven A. Goldstein MD FACC FASE Professor of Medicine Georgetown University Medical Center MedStar Heart Institute Washington Hospital Center Monday, October 10, 2017 DISCLOSURE

More information

Transcatheter Aortic Valve Implantation Management of risks and complications

Transcatheter Aortic Valve Implantation Management of risks and complications Transcatheter Aortic Valve Implantation Management of risks and complications TAVI Summit, Seoul, Korea, Spetember 3rd, 2011 Alain Cribier University of Rouen, France Complications of TAVI Depending on

More information

Potential Conflicts of Interest. Speaker s fee / Consultancy:

Potential Conflicts of Interest. Speaker s fee / Consultancy: Potential Conflicts of Interest ESC Stockholm 2010 Bernard Iung, MD Speaker s fee / Consultancy: St. Jude Medical Edwards Lifesciences Sanofi-Aventis Servier Boehringer Ingelheim Acute Decompensation of

More information

ISCHEMIC REPAIR. MITRAL REGURGITATION Edwards Lifesciences -Consultant Saint Jude Medical-Consultant Sorin-Consultant. Prof. Dr. R.

ISCHEMIC REPAIR. MITRAL REGURGITATION Edwards Lifesciences -Consultant Saint Jude Medical-Consultant Sorin-Consultant. Prof. Dr. R. REPAIR ISCHEMIC MITRAL REGURGITATION Edwards Lifesciences -Consultant Saint Jude Medical-Consultant Sorin-Consultant Prof. Dr. R. Dion Genk - Belgium KULeuven REPAIR ISCHEMIC MITRAL REGURGITATION Prof.

More information

MITRAL REGURGITATION ECHO PARAMETERS TOOL

MITRAL REGURGITATION ECHO PARAMETERS TOOL Comprehensive assessment of qualitative and quantitative parameters, along with the use of standardized nomenclature when reporting echocardiographic findings, helps to better define a patient s MR and

More information

TRANSCATHETER HEART VALVE PROCEDURES

TRANSCATHETER HEART VALVE PROCEDURES UnitedHealthcare Commercial Medical Policy TRANSCATHETER HEART VALVE PROCEDURES Policy Number: 2018T0557N Effective Date: February 1, 2018 Table of Contents Page INSTRUCTIONS FOR USE... 1 BENEFIT CONSIDERATIONS...

More information

Il Cuore in Fortezza Savona, 9 Aprile 2015

Il Cuore in Fortezza Savona, 9 Aprile 2015 Il Cuore in Fortezza Savona, 9 Aprile 2015 Alaide Chieffo UO Emodinamica Ospedale San Raffaele, Milano Improvements for treatments of ST elevation myocardial infarction DES and New DES Functional revascularization

More information

TRANSCATHETER HEART VALVE PROCEDURES

TRANSCATHETER HEART VALVE PROCEDURES UnitedHealthcare Oxford Clinical Policy TRANSCATHETER HEART VALVE PROCEDURES Policy Number: CARDIOLOGY 024.12 T2 Effective Date: November 1, 2017 Table of Contents Page INSTRUCTIONS FOR USE... 1 CONDITIONS

More information

Coronary Sinus Annuloplasty for Mitral Regurgitation A look at several devices with the ability to reduce functional mitral regurgitation.

Coronary Sinus Annuloplasty for Mitral Regurgitation A look at several devices with the ability to reduce functional mitral regurgitation. Coronary Sinus Annuloplasty for Mitral Regurgitation A look at several devices with the ability to reduce functional mitral regurgitation. BY STEVEN L. GOLDBERG, MD The term functional mitral regurgitation

More information

Percutaneous Aortic Valve Replacement with the Medtronic-CoreValve System

Percutaneous Aortic Valve Replacement with the Medtronic-CoreValve System Percutaneous Aortic Valve Replacement with the Medtronic-CoreValve System Raoul Bonan, MD Institut de Cardiologie de Montreal Summit TCT Asia Pacific 2009 Disclosure Information Raoul Bonan, MD I have

More information

Multicentre clinical study evaluating a novel resheatable self-expanding transcatheter aortic valve system

Multicentre clinical study evaluating a novel resheatable self-expanding transcatheter aortic valve system Multicentre clinical study evaluating a novel resheatable self-expanding transcatheter aortic valve system Preliminary Results: Acute and 1-year Outcomes Ganesh Manoharan, MBBCh, MD, FRCP Consultant Cardiologist

More information

TAVR y Enfermedad Coronaria. Mauricio G. Cohen, MD, FACC, FSCAI Director, Cardiac Catheterization Lab Associate Professor of Medicine

TAVR y Enfermedad Coronaria. Mauricio G. Cohen, MD, FACC, FSCAI Director, Cardiac Catheterization Lab Associate Professor of Medicine TAVR y Enfermedad Coronaria Mauricio G. Cohen, MD, FACC, FSCAI Director, Cardiac Catheterization Lab Associate Professor of Medicine CAD and AS Similar Pathological Processes CAD in TAVR Patients (n=390)

More information

Transcatheter Aortic-Valve Implantation for Aortic Stenosis

Transcatheter Aortic-Valve Implantation for Aortic Stenosis Transcatheter Aortic-Valve Implantation for Aortic Stenosis Policy Number: Original Effective Date: MM.06.019 10/01/2012 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 05/26/2017

More information

Integration of AVC within the Broader Health System: Barriers and Possible Solutions

Integration of AVC within the Broader Health System: Barriers and Possible Solutions Integration of AVC within the Broader Health System: Barriers and Possible Solutions Vinod H. Thourani, MD Professor of Cardiothoracic Surgery Chief of Cardiothoracic Surgery, Emory Hospital Midtown Co-Director,

More information

The clinical problem of atrioventricular valve regurgitation

The clinical problem of atrioventricular valve regurgitation Mitral Regurgitation in Congenital Heart Defects: Surgical Techniques for Reconstruction Richard G. Ohye Mitral valve regurgitation (MR) is an important source of morbidity and mortality worldwide. While

More information

Echocardiographic Evaluation of the Cardiomyopathies. Stephanie Coulter, MD, FACC, FASE April, 2016

Echocardiographic Evaluation of the Cardiomyopathies. Stephanie Coulter, MD, FACC, FASE April, 2016 Echocardiographic Evaluation of the Cardiomyopathies Stephanie Coulter, MD, FACC, FASE April, 2016 Cardiomyopathies (CMP) primary disease intrinsic to cardiac muscle Dilated CMP Hypertrophic CMP Infiltrative

More information

The icoapsys Repair System for the percutaneous treatment of functional mitral insufficiency

The icoapsys Repair System for the percutaneous treatment of functional mitral insufficiency Percutaneous valve interventions The icoapsys Repair System for the percutaneous treatment of functional mitral insufficiency Wes R. Pedersen 1 *, MD, FACC, FSCAI; Peter Block 2, MD, FACC, FSCAI; Ted Feldman

More information

Aortic Stenosis and TAVR 5/3/2017

Aortic Stenosis and TAVR 5/3/2017 Transcatheter Aortic Valve Replacement Stan Watkins, MD MHS FACC Feb 3, 2017 Disclosure of Financial Interest Partner at Alaska Heart Institute No financial relationships with device manufacturers Member

More information

Echocardiographic assessment of Prosthetic Valves

Echocardiographic assessment of Prosthetic Valves Echocardiographic assessment of Prosthetic Valves Michael H. Picard, M.D. Massachusetts General Hospital Harvard Medical School No disclosures J Am Soc Echocardiogr 2009;22:976-1014 The bottom line Routine

More information

TAVI: 10 Years After the First Case Low-Risk and High-Risk Patients What are the Limits? Dr Bernard Prendergast DM FRCP FESC John Radcliffe Hospital

TAVI: 10 Years After the First Case Low-Risk and High-Risk Patients What are the Limits? Dr Bernard Prendergast DM FRCP FESC John Radcliffe Hospital TAVI: 10 Years After the First Case Low-Risk and High-Risk Patients What are the Limits? Dr Bernard Prendergast DM FRCP FESC John Radcliffe Hospital Oxford I have financial relationships to disclose Honoraria

More information

LVOT Obstruction: Patients at Risk. Edwin G. Avery, M.D. Chief, Case Cardiac Anesthesia Group Fall 2011 Cardiac Anesthesia TEE Conference

LVOT Obstruction: Patients at Risk. Edwin G. Avery, M.D. Chief, Case Cardiac Anesthesia Group Fall 2011 Cardiac Anesthesia TEE Conference LVOT Obstruction: Patients at Risk Edwin G. Avery, M.D. Chief, Case Cardiac Anesthesia Group Fall 2011 Cardiac Anesthesia TEE Conference Disclosures Covidien: funded research, consultant Alere: funded

More information

Cerebral protection devices are still meaningful and necessary

Cerebral protection devices are still meaningful and necessary TVT 2015 Chicago, June 5 nd, 2015 Cerebral protection devices are still meaningful and necessary Eberhard Grube MD, FACC, FSCAI University Hospital, Dept of Medicine II, Bonn, Germany Stanford University,

More information

CoreValve Evolut R Technology review and Clinical Results. Paul TL Chiam

CoreValve Evolut R Technology review and Clinical Results. Paul TL Chiam CoreValve Evolut R Technology review and Clinical Results Paul TL Chiam MBBS (S pore), MMed, MRCP (UK), FAMS FRCP (Edin), FESC (EU), FACC (USA), FSCAI (USA) Cardiologist Mount Elizabeth Hospital Singapore

More information

Ischemic mitral regurgitation (IMR) is an insufficiency of

Ischemic mitral regurgitation (IMR) is an insufficiency of Repair Techniques for Ischemic Mitral Regurgitation Damien J. LaPar, MD, MSc, and Irving L. Kron, MD Ischemic mitral regurgitation (IMR) is an insufficiency of the mitral valve (MV) secondary to myocardial

More information

Interventional procedures guidance Published: 26 July 2017 nice.org.uk/guidance/ipg586

Interventional procedures guidance Published: 26 July 2017 nice.org.uk/guidance/ipg586 Transcatheter aortic valve implantation for aortic stenosis Interventional procedures guidance Published: 26 July 17 nice.org.uk/guidance/ipg586 Your responsibility This guidance represents the view of

More information

Transcatheter Heart Valve Procedures

Transcatheter Heart Valve Procedures Medical Coverage Policy Transcatheter Heart Valve Procedures Table of Contents Coverage Policy... 1 Overview... 2 General Background... 2 Coding/Billing Information... 27 References... 29 Effective Date...11/15/2017

More information

16 YEAR RESULTS Carpentier-Edwards PERIMOUNT Mitral Pericardial Bioprosthesis, Model 6900

16 YEAR RESULTS Carpentier-Edwards PERIMOUNT Mitral Pericardial Bioprosthesis, Model 6900 CLINICAL COMMUNIQUé 6 YEAR RESULTS Carpentier-Edwards PERIMOUNT Mitral Pericardial Bioprosthesis, Model 69 The Carpentier-Edwards PERIMOUNT Mitral Pericardial Valve, Model 69, was introduced into clinical

More information

Echocardiographic Evaluation of Hemodynamic Severity

Echocardiographic Evaluation of Hemodynamic Severity Echocardiographic Evaluation of Hemodynamic Severity Steven J. Lester MD, FACC, FRCP(C), FASE Mayo Clinic, Arizona Relevant Financial Relationship(s) None Off Label Usage None 1 Percent 2/16/2017 A re-emerging

More information

Candice Silversides, MD Toronto Congenital Cardiac Centre for Adults University of Toronto Toronto, Canada

Candice Silversides, MD Toronto Congenital Cardiac Centre for Adults University of Toronto Toronto, Canada PVR Following Repair of TOF Now? When? Candice Silversides, MD Toronto Congenital Cardiac Centre for Adults University of Toronto Toronto, Canada Late Complications after TOF repair Repair will be necessary

More information

Establishing a New Path Forward for Patients With Severe Symptomatic Aortic Stenosis THE PARTNER TRIAL CLINICAL RESULTS

Establishing a New Path Forward for Patients With Severe Symptomatic Aortic Stenosis THE PARTNER TRIAL CLINICAL RESULTS Establishing a New Path Forward for Patients With Severe Symptomatic Aortic Stenosis THE PARTNER TRIAL CLINICAL RESULTS E D W A R D S T R A N S C A T H E T E R H E A R T V A L V E P R O G R A M T h e Pa

More information

Transcatheter aortic valve implantation for aortic stenosis

Transcatheter aortic valve implantation for aortic stenosis NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Interventional procedure consultation document Transcatheter aortic valve implantation for aortic stenosis Aortic stenosis occurs when the aortic valve

More information

Regurgitant Lesions. Bicol Hospital, Legazpi City, Philippines July Gregg S. Pressman MD, FACC, FASE Einstein Medical Center Philadelphia, USA

Regurgitant Lesions. Bicol Hospital, Legazpi City, Philippines July Gregg S. Pressman MD, FACC, FASE Einstein Medical Center Philadelphia, USA Regurgitant Lesions Bicol Hospital, Legazpi City, Philippines July 2016 Gregg S. Pressman MD, FACC, FASE Einstein Medical Center Philadelphia, USA Aortic Insufficiency Valve anatomy and function LVOT and

More information

Introducing transcatheter aortic valve implantation with a new generation prosthesis: Institutional learning curve and effects on acute outcomes

Introducing transcatheter aortic valve implantation with a new generation prosthesis: Institutional learning curve and effects on acute outcomes Neth Heart J (2017) 25:106 115 DOI 10.1007/s12471-016-0925-4 ORIGINAL ARTICLE Introducing transcatheter aortic valve implantation with a new generation prosthesis: Institutional learning curve and effects

More information

Critical Elements of the Team

Critical Elements of the Team Prof. Dr. Rui M. S. Almeida Faculty Assis Gurgacz - Medical School Dean Professor of Cardiology and Cardiovascular Surgery - Unioeste Scientific Director of the Brazilian Society of Cardiovascular Surgery

More information

ESC / EACTS new valvular guidelines- Update

ESC / EACTS new valvular guidelines- Update ESC / EACTS new valvular guidelines- Update Yaron Shapira, MD The Dan Sheingarten echocardiography & valve clinic Rabin Medical Center, Beilinson Hospital, Petah-Tiqva Tel-Aviv University ESC valve guidelines

More information

Transcatheter Heart Valve Therapy

Transcatheter Heart Valve Therapy Edwards Lifesciences 2017 Investor Conference Transcatheter Heart Valve Therapy Larry L. Wood Corporate Vice President, Transcatheter Heart Valves Leader in ~$3B Global Transcatheter Heart Valves Primary

More information

Influence of patient gender on mortality after aortic valve replacement for aortic stenosis

Influence of patient gender on mortality after aortic valve replacement for aortic stenosis Influence of patient gender on mortality after aortic valve replacement for aortic stenosis Jennifer Higgins, MD, W. R. Eric Jamieson, MD, Osama Benhameid, MD, Jian Ye, MD, Anson Cheung, MD, Peter Skarsgard,

More information

Mitral-Valve Repair versus Replacement for Severe Ischemic Mitral Regurgitation

Mitral-Valve Repair versus Replacement for Severe Ischemic Mitral Regurgitation The new england journal of medicine Original Article Mitral-Valve Repair versus Replacement for Severe Ischemic Mitral Regurgitation Michael A. Acker, M.D., Michael K. Parides, Ph.D., Louis P. Perrault,

More information

Ashraf Elsakr, M.D., F.A.C.C.

Ashraf Elsakr, M.D., F.A.C.C. 1 Ashraf Elsakr, M.D., F.A.C.C. Director of the Cardiac Catheterization Lab/ Interventional Cardiology Program Florida Hospital Memorial, Daytona Beach, Fl Nothing to disclose 2 3 Stage Definition Valve

More information

Aortic Stenosis: Spectrum of Disease, Low Flow/Low Gradient and Variants

Aortic Stenosis: Spectrum of Disease, Low Flow/Low Gradient and Variants Aortic Stenosis: Spectrum of Disease, Low Flow/Low Gradient and Variants Martin G. Keane, MD, FASE Professor of Medicine Lewis Katz School of Medicine at Temple University Basic root structure Parasternal

More information

R. Hahn: Echo for TAVR

R. Hahn: Echo for TAVR TAVR: Procedure Guidance by Echo Rebecca T. Hahn, MD Associate Professor of Medicine/Columbia University Director of Interventional Echocardiography I, Rebecca T. Hahn, MD DO NOT have a financial interest/arrangement

More information

Valvular Imaging Optimizing Data Acquisition and Interpretation

Valvular Imaging Optimizing Data Acquisition and Interpretation Valvular Imaging Optimizing Data Acquisition and Interpretation Suhny Abbara, MD Director Cardiovascular Imaging Section, Massachusetts General Hospital Assistant Professor, Harvard Medical School Sabbara@Partners.org

More information

Usually we DON T need to go beyond the gradient

Usually we DON T need to go beyond the gradient Aortic Stenosis Going Beyond the Gradient James D. Thomas, MD, FACC, FASE Director, Center for Heart Valve Disease Bluhm Cardiovascular Institute Professor of Medicine, Feinberg School of Medicine, Northwestern

More information

3D Computer Modeling of Bicuspid Aortic Valve Repair

3D Computer Modeling of Bicuspid Aortic Valve Repair 3D Computer Modeling of Bicuspid Aortic Valve Repair Robert Gorman, M.D. Alison Pouch, Ph.D. Gorman Cardiovascular Research Group, Department of Surgery Why 3DE? What have we learned from the mitral valve

More information

Mitral Gradients and Frequency of Recurrence of Mitral Regurgitation After Ring Annuloplasty for Ischemic Mitral Regurgitation

Mitral Gradients and Frequency of Recurrence of Mitral Regurgitation After Ring Annuloplasty for Ischemic Mitral Regurgitation Mitral Gradients and Frequency of Recurrence of Mitral Regurgitation After Ring Annuloplasty for Ischemic Mitral Regurgitation Matthew L. Williams, MD, Mani A. Daneshmand, MD, James G. Jollis, MD, John

More information

Revolutionizing how advanced heart disease is treated. Alexei Marko, CEO Chris Clark, CFO November 2014

Revolutionizing how advanced heart disease is treated. Alexei Marko, CEO Chris Clark, CFO November 2014 Revolutionizing how advanced heart disease is treated Alexei Marko, CEO Chris Clark, CFO November 2014 Forward-Looking Statements Statements contained herein that are not based on historical or current

More information

Clinical material and methods. Copyright by ICR Publishers 2007

Clinical material and methods. Copyright by ICR Publishers 2007 16847_JHVD_Biancari_3197_(116-121)_r1:Layout 1 21/3/07 17:07 Page 116 Predicting Immediate and Late Outcome after Surgery for Mitral Valve Regurgitation with EuroSCORE Jouni Heikkinen, Fausto Biancari,

More information

What is Ebstein Anomaly?

What is Ebstein Anomaly? Echocardiograpnhic Evaluation of : Definition, Detection and Determinants of Outcome P. W. O Leary, M.D. Division of Pediatric Cardiology Mayo Clinic No Conflicts to Disclose What is? Failure of the TV

More information

BIOFREEDOM: Polymer free Biolimus A9 eluting

BIOFREEDOM: Polymer free Biolimus A9 eluting TCTAP 2011 Seoul, April 27 29, 2011 BIOFREEDOM: Polymer free Biolimus A9 eluting Stents and Paclitaxel eluting stents Eberhard Grube MD, FACC, FSCAI Hospital Oswaldo Cruz - Dante Pazzanese, São Paulo,

More information

Congenital Heart Disease I: The Unrepaired Adult

Congenital Heart Disease I: The Unrepaired Adult Congenital Heart Disease I: The Unrepaired Adult Doreen DeFaria Yeh, MD FACC Assistant Professor, Harvard Medical School MGH Adult Congenital Heart Disease Program Echocardiography Section. No disclosures

More information

Transcatheter Aortic Valve Replacement

Transcatheter Aortic Valve Replacement INTERMEDIATE OR GREATER RISK Transcatheter Aortic Valve Replacement with the Edwards SAPIEN 3 Transcatheter Heart Valve For Patients & Caregivers This patient booklet is for those who are suffering from

More information

ICE: Echo Core Lab-CRF

ICE: Echo Core Lab-CRF APPENDIX 1 ICE: Echo Core Lab-CRF Study #: - Pt Initials: 1. Date of study: / / D D M M M Y Y Y Y 2. Type of Study: TTE TEE 3. Quality of Study: Poor Moderate Excellent Ejection Fraction 4. Ejection Fraction

More information

P = 4V 2. IVC Dimensions 10/20/2014. Comprehensive Hemodynamic Evaluation by Doppler Echocardiography. The Simplified Bernoulli Equation

P = 4V 2. IVC Dimensions 10/20/2014. Comprehensive Hemodynamic Evaluation by Doppler Echocardiography. The Simplified Bernoulli Equation Comprehensive Hemodynamic Evaluation by Doppler Echocardiography Itzhak Kronzon, MD North Shore LIJ/ Lenox Hill Hospital New York, NY Disclosure: Philips Healthcare St. Jude Medical The Simplified Bernoulli

More information

Stress Echocardiography: Illustrative Cases Sunil Mankad, MD, FACC, FCCP, FASE Associate Professor of Medicine Mayo Clinic College of Medicine Director, Transesophageal Echocardiography Associate Director,

More information

Aortic Stenosis and Perioperative Risk With Non-cardiac Surgery

Aortic Stenosis and Perioperative Risk With Non-cardiac Surgery Aortic Stenosis and Perioperative Risk With Non-cardiac Surgery Aortic stenosis (AS) is characterized as a high-risk index for cardiac complications during non-cardiac surgery. A critical analysis of old

More information

Mitral valve repair is the treatment of choice for most. Hemolysis After Mitral Valve Repair: Mechanisms and Treatment

Mitral valve repair is the treatment of choice for most. Hemolysis After Mitral Valve Repair: Mechanisms and Treatment Hemolysis After Mitral Valve Repair: Mechanisms and Treatment Buu-Khanh Lam, MD, Delos M. Cosgrove III, MD, Sunil K. Bhudia, MD, and A. Marc Gillinov, MD Department of Thoracic and Cardiovascular Surgery,

More information

Antithrombotic. DAPT or OAC?

Antithrombotic. DAPT or OAC? Antithrombotic treatment after TAVI: DAPT or OAC? Striking the right balance. Pascal Vranckx MD, PhD. Hartcentrum Hasselt, Belgium. Disclosure of Interest Pascal Vranckx has the following potential conflicts

More information

Comprehensive Hemodynamics By Doppler Echocardiography. The Echocardiographic Swan-Ganz Catheter.

Comprehensive Hemodynamics By Doppler Echocardiography. The Echocardiographic Swan-Ganz Catheter. Comprehensive Hemodynamics By Doppler Echocardiography. The Echocardiographic Swan-Ganz Catheter. Itzhak Kronzon, MD, FASE, FACC, FESC, FAHA, FACP, FCCP North Shore HS, LIJ/Lenox Hill Hospital, New York

More information

Nothing to Disclose. Questions. Disclosure Asymptomatic Severe Aortic Stenosis: (When) Should One Intervene? Paul Wood at the Nathanson Lecture, 1958

Nothing to Disclose. Questions. Disclosure Asymptomatic Severe Aortic Stenosis: (When) Should One Intervene? Paul Wood at the Nathanson Lecture, 1958 Disclosure Asymptomatic Severe Aortic Stenosis: (When) Should One Intervene? Nothing to Disclose Gabriel Gregoratos, MD, FACC, FAHA Questions Can one improve globally on the asymptomatic state? and if

More information

Assessment and Management of Low Flow Low Gradient AS with Preserved LV Systolic Function

Assessment and Management of Low Flow Low Gradient AS with Preserved LV Systolic Function Assessment and Management of Low Flow Low Gradient AS with Preserved LV Systolic Function Joseph F. Malouf MD, FACC, FAHA, FASE Director, Interventional Echocardiography Professor of Medicine, Mayo Clinic

More information

Valve Disease. Valve Surgery. In 2015, Cleveland Clinic surgeons performed 2943 valve surgeries.

Valve Disease. Valve Surgery. In 2015, Cleveland Clinic surgeons performed 2943 valve surgeries. Valve Surgery 11 15 Volume 3 1 11 1 13 1 N = 1 773 5 79 15 93 In 15, surgeons performed 93 valve surgeries. surgeons have implanted more than 1,5 bioprosthetic aortic valves since the 199s, with excellent

More information

Transcatheter/Hybrid Aortic Valves in the Young

Transcatheter/Hybrid Aortic Valves in the Young Transcatheter/Hybrid Aortic Valves in the Young Prof. Dr. Mirko Doss Kerckhoff Klinik, Bad Nauheim AVR vs TAVR Implants Isolierte Aortenklappenchirurgie 1994-2010 ohne kathetergeführte Eingriffe Kunstklappe

More information

Mesenchymal Precursor Cells as Adjunctive Therapy in Contemporary LVAD Recipients

Mesenchymal Precursor Cells as Adjunctive Therapy in Contemporary LVAD Recipients Mesenchymal Precursor Cells as Adjunctive Therapy in Contemporary LVAD Recipients Deborah D. Ascheim, MD A.C. Gelijns, D. Goldstein, L.A. Moye, N. Smedira, S. Lee, C.T. Klodell, A. Szady, M. K. Parides,

More information

Management of significant asymptomatic aortic stenosis. Alec Vahanian Bichat Hospital University Paris VII Paris, France

Management of significant asymptomatic aortic stenosis. Alec Vahanian Bichat Hospital University Paris VII Paris, France Management of significant asymptomatic aortic stenosis. Alec Vahanian Bichat Hospital University Paris VII Paris, France Background Aortic stenosis (AS) is the most frequent valve disease among referred

More information

Will Cerebral Emboli Protection Devices Reduce Stroke After TAVR. E Murat Tuzcu, MD Cleveland Clinic

Will Cerebral Emboli Protection Devices Reduce Stroke After TAVR. E Murat Tuzcu, MD Cleveland Clinic Will Cerebral Emboli Protection Devices Reduce Stroke After TAVR E Murat Tuzcu, MD Cleveland Clinic Murat Tuzcu No financial disclosures Member of PARTNER Trial executive committee PARTNER B: Impact of

More information

Section 1: Initial Evaluation for Valvular Heart Disease Table 1: Initial Evaluation of an Asymptomatic Patient

Section 1: Initial Evaluation for Valvular Heart Disease Table 1: Initial Evaluation of an Asymptomatic Patient Section 1: Initial Evaluation for Valvular Heart Disease Table 1: Initial Evaluation of an Asymptomatic Patient Indication 1. Unexplained murmur or abnormal heart sounds 2. Reasonable suspicion of valvular

More information

New Imaging for Aortic Valve Disease. Anthony DeMaria Judy and Jack White Chair Director, Sulpizio CV Center University of California, San Diego

New Imaging for Aortic Valve Disease. Anthony DeMaria Judy and Jack White Chair Director, Sulpizio CV Center University of California, San Diego New Imaging for Aortic Valve Disease Anthony DeMaria Judy and Jack White Chair Director, Sulpizio CV Center University of California, San Diego Imaging in Aortic Stenosis Valve morphology calcification

More information

The Case for Mechanical Valves

The Case for Mechanical Valves The Case for Mechanical Valves Hartzell V. Schaff, MD 2011 MFMER slide-1 Prosthetic Devices Mayo Clinic Total 1424 (363 rings) 336 mechanical valves (32%) 725 tissue valves (68%) AVR, 19% mechanical (STS

More information

abstract n engl j med 374;20 nejm.org May 19,

abstract n engl j med 374;20 nejm.org May 19, The new england journal of medicine established in 1812 May 19, 2016 vol. 374 no. 20 Rate Control versus Rhythm Control for Atrial Fibrillation after Cardiac Surgery A.M. Gillinov, E. Bagiella, A.J. Moskowitz,

More information

Valvular disease : Ο ρόλος του CMR. Sophie Mavrogeni MD FESC. Onassis Cardiac Surgery Center Athens Greece

Valvular disease : Ο ρόλος του CMR. Sophie Mavrogeni MD FESC. Onassis Cardiac Surgery Center Athens Greece Valvular disease : Ο ρόλος του CMR Sophie Mavrogeni MD FESC Onassis Cardiac Surgery Center Athens Greece Aortic Valve CMR EVALUATION OF AORTIC VALVE Phase-contrast CMR of the aorta to determine aortic

More information

ADVANCED TAVI IMAGING

ADVANCED TAVI IMAGING Program Directors Antonio Colombo, MD, Milan, Italy Markus Kasel, MD, Munich, Germany Susheel K. Kodali, MD, New York, NY Martin B. Leon, MD, New York, NY ADVANCED TAVI IMAGING 7 Program Wednesday 03.12.2014

More information

Pediatric Therapeutic Catheterization. Stuart Berger, M.D. Director, Heart Center UC Davis Children s Hospital May 2, 2015

Pediatric Therapeutic Catheterization. Stuart Berger, M.D. Director, Heart Center UC Davis Children s Hospital May 2, 2015 Pediatric Therapeutic Catheterization Stuart Berger, M.D. Director, Heart Center UC Davis Children s Hospital May 2, 2015 A Century of Cardiology Prostaglandins Balloon atrial Septostomy Intervention Echocardiography

More information

Cardiac catheterisation in AS

Cardiac catheterisation in AS AORTIC STENOSIS MANAGEMENT OF VALVULAR AORTIC STENOSIS Dr Badri Paudel Third most common cardiovascular disease Most prevalent valvular heart disease in the world Commonest acquired valvular lesion with

More information

Aortic Valve Stenosis. Postoperative Evaluation and Outcome Following Aortic Valve Replacement

Aortic Valve Stenosis. Postoperative Evaluation and Outcome Following Aortic Valve Replacement Aortic Valve Stenosis Postoperative Evaluation and Outcome Following Aortic Valve Replacement Raphael Rosenhek Department of Cardiology Medical University of Vienna Euroecho 2011 Budapest, December 9 th

More information

Clinical material and methods. Fukui Cardiovascular Center, Fukui, Japan

Clinical material and methods. Fukui Cardiovascular Center, Fukui, Japan Mitral Valve Regurgitation after Atrial Septal Defect Repair in Adults Shohei Yoshida, Satoshi Numata, Yasushi Tsutsumi, Osamu Monta, Sachiko Yamazaki, Hiroyuki Seo, Takaaki Samura, Hirokazu Ohashi Fukui

More information