Mitral Valve Disease. James Hermiller, MD, FACC, FSCAI St Vincent Heart Center Indianapolis, IN
|
|
|
- Carmella Lee
- 6 years ago
- Views:
Transcription
1 Mitral Valve Disease James Hermiller, MD, FACC, FSCAI St Vincent Heart Center Indianapolis, IN
2 Disclosures Affiliation/Financial Relationship Consulting Fees/Honoraria Speaker Bureau Company Abbott, BSC, Medtronic, Edwards and St Jude Medicines Company, Astra-Zeneca
3 Outline Introduction Transcatheter Repair MitraClip Annular Approaches TMVR Summary/Conclusions
4 Complexity Mitral Valve Aortic Valve Complex Simple
5 Euro Heart Survey: Surgery for Functional Mitral Regurgitation Not an Option Isolated MR (n=877) No Severe MR (n=331) Severe MR (n=546) No Symptoms (n=144) Symptoms (n=396) Mirabel et al, European Heart J 2007;28: No Intervention (n=193) 49% Intervention (n=203) 51%
6 Outline Introduction Transcatheter Repair MitraClip Annular Approaches TMVR Summary/Conclusions
7 Edge-to-Edge Technique Ottavio Alfieri Maisano. JACC 2011;58:
8
9 In the Beginning: Lost
10 In the Beginning: Confused Steerable Sleeve Guiding Catheter Delivery Catheter MitraClip
11 In the Beginning: Off Target
12 Ahah!!!!
13 Transseptal 30 0 MEDIAL 60 0 FOSSA P3 A3 A2 P2 POSTERIOR AO A1 P ANTERIOR LAA LATERAL
14 Essential: 3D Imaging 3D TEE
15 Lining up the Clip: Trajectory Aligning the Clip so the DC shaft is perpendicular to the plane of the mitral valve
16 Grasping Leaflets Systematic Confirmation of Grasp Success Slow Pull-Back Leaflets Fall In
17 Confirming: Leaflet Grasp Wait Look
18 MitraClip
19 MitraClip Surgical candidates- 5 year EVEREST II randomized trial High risk global experience Improved symptoms, procedural safety, short stays Decreased heart failure hospitalizations Expanded anatomic substrates High risk FMR US COAPT Trial Randomized MitraClip vs GDMT ± CRT
20 CONCLUSIONS Although percutaneous repair was less effective at reducing mitral regurgitation than conventional surgery, the procedure was associated with superior safety and similar improvements in clinical outcomes.
21 Percent of patients 5 year Follow-Up Mitral Regurgitation Grade EVEREST II RCT All Treated Patients (N=258) Residual MR with MitraClip 1+ Baseline MitraClip 5 Years Surgery 5 Years
22 Mean SLAD diast (cm) Mean SLAD diast (cm) 5 p<0.05 Stability of Mitral Annular Dimensions DMR MitraClip (N=130) p=0.18 Diastolic SLAD 5 p=0.07 FMR MitraClip (N=48) p= BL 1 Year BL 5 Years N=92 N=72 N = survivors with paired data; p-values for descriptive purposes only 0 BL 1 Year BL 5 Years N=32 N=18
23 Long-Term MitraClip Device Safety EVEREST II RCT Through 1 Year # (%) of patients 1 Year to 5 Years # (%) of patients Single Leaflet Device Attachment (SLDA) 10 (6.3%) 0 (0.0%) MV stenosis 1 (0.6%) 0 (0.0%) Device Embolization 0 (0.0%) 0 (0.0%) Based on N=158 who were implanted with 1 or 2 MitraClip devices
24 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
25 Endovascular Valve Edge-to-Edge REpair STudy Subgroup Analyses for the Primary End Point at 12 Months Feldman T et al. N Engl J Med 2011;364:
26 The percutaneous mitral valve device significantly reduced MR, improved clinical symptoms, and decreased LV dimensions at 12months in this high-surgical-risk cohort. Glower, et al. J Am Coll Cardiol 2014;64:172 81
27 The EVEREST II High Surgical Risk Cohort n=351 Age 76 ± 11 Predicted Surgical Mortality Risk, (%) 18.2±8.4 NYHA Functional Class III or IV 85% Atrial Fibrillation 69% Mitral Regurgitation Grade 3+ 86% Left Ventricular Ejection Fraction (%) 47.5 ± 14.2 Functional MR 70% 30 day Mortality 6.8% Home ± home health care 91.7 % MR Grade I-II at 2 years 87% Decrease LV EDV/ESV at 1 year 17.9 / 8.1 ml Event Free Survival 1 year 77.1%
28 Mean Volume (ml) Left Ventricular Volumes Left Ventricular End Diastolic Volume Left Ventricular End Systolic Volume Mean = ml 97.5% UCB = ml p< Mean = -8.1 ml 97.5% UCB = -4.8 ml p< Baseline 1 Year Baseline 1 Year Paired data (N=203) Paired data (N=202)
29 HF Hospitalization Rate Per Patient Year Hospitalizations for Heart Failure % reduction p< Year Prior to MitraClip 0.41 N=351 N=338 1 Year Post Discharge All treated
30 Lim SD et al. J Am Coll Cardiol 2014;64: TMVR in prohibitive surgical risk patients is associated with safety and good clinical outcomes, including decreases in rehospitalization, functional improvements, and favorable ventricular remodeling, at 1 year.
31 Baseline Demographics and Comorbidities Characteristic Age (mean ± SD) Prohibitive Risk DMR N = ± 9 years Patients over 75 years of age 84% Male Gender 55% Coronary Artery Disease 73% Prior Myocardial Infarction 24% Previous Cardiovascular Surgery 48% Atrial Fibrillation History 71% Prior Stroke 10% Diabetes 30% Moderate to Severe Renal Disease 28% Chronic Obstructive Pulmonary Disease 32% STS Mortality Risk (mean ± SD) [v2.73, replacement] 13.2 ± 7.3% SF-36 QoL Physical Component Score (mean ± SD) 32.0 ± 8.7 SF-36 QoL Mental Component Score (mean ± SD) 46.1 ± 12.5
32 Post-Procedural and Discharge Results Post-Procedural and Discharge Results Post-Procedural (mean ± SD) ICU/CCU duration Length of hospital stay Prohibitive Risk DMR N = ± 1.8 days 2.9 ± 3.1 days Discharge MR, (%) MR 2+ at Discharge 82% MR 1+ at Discharge 54% Discharged home, (%) 87% MitraClip implant success 95.3%;
33 MitraClip in Prohibitive-risk DMR Pts 141 pts from EVEREST studies. Mean age 82 years, 87% NYHA III/IV, mean STS score 13.2%. MitraClip implant success 95.3%; hospital stay 2.9 ± 3.1 days. 30-Day Adverse Events: Death* 6.3% Myocardial infarction* 0.8% Non-elective CV surgery for adverse events* 0.8% Stroke* 2.4% New onset of permanent AF* 0% Renal failure 1.6% Ventilation >48 hours* 3.1% GI complication requiring surgery* 0.8 Major vascular complications 5.5% Major bleeding ( 2U or surgery for rebleeding) 12.6% Non-cerebral thromboembolism 1.6% Heart block/arrhythmia requiring perm pacemaker 0% Atrial septal defect 1.6% Mitral stenosis 0% Lim SD et al. J Am Coll Cardiol 2014;64: *CEC adjudicated.
34 Patients (%) MitraClip in Prohibitive-risk DMR Pts MR Grade Through 1 Year Patients With Data Available at Follow-Up (Completers Analysis) MR 2+ in 83% of surviving pts at 1 year Baseline N= Discharge N= Year N=84 Lim SD et al. J Am Coll Cardiol 2014;64:182 92
35 MitraClip in Prohibitive-risk DMR Pts 141 pts from EVEREST studies. Mean age 82 years, 87% NYHA III/IV, mean STS score 13.2%. LV Remodeling, Functional Class and Rehospitilization for CHF
36 MitraClip Systematic Review MitraClip vs Surgery 30 Day Outcomes High Risk Patients MitraClip Surgery n=3198 n= Death Stroke Bleeding Prolonged Vent ICU Days Hospital Days 21 studies PhilipF et al, Cathet Cardiovasc Intervent 84:581, 2014
37 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
38 History 87 year old man with a history of moderate MR and MVP Stable when he developed flash pulmonary edema 3 months prior to presentation Echo revealed 4+ MR with a flail leaflet; EF 60%; Flow reversal in Pas Refractory CHF Turned down for OHS Offered Hospice He declined
39 Pre-TEE
40 Pre TEE
41 Pre TEE Intercommisural
42 Pre-Imaging 3D
43 Clip To Valve Trajectory Orientation Location
44 2 nd Clip
45 Confirm Grasp, R/O MS, and Release 2 nd Clip
46 Follow Up Home following day Uneventful hospital course 6 months Echo 1+ mild MR Functional class 1 Back golfing Walking 3 miles
47 Therapy for MR Degenerative Functional Low Surgical Risk Surgical Mitral Repair? High Surgical Risk Commercial MitraClip COAPT
48 Clinical Outcomes Assessment of the MitraClip Percutaneous Therapy for High Surgical Risk ~430 patients enrolled at up to 75 US sites Significant FMR 3+ core lab; EF<50%; CHF hospitalization or BNP>300 High risk for mitral valve surgery- Local Heart Team Specific valve anatomic criteria Randomize 1:1 MitraClip Control group Standard of care Safety: Composite death, stroke, worsening renal function, LVAD implant, heart transplant at 12 months Effectiveness: Recurrent heart failure hospitalizations Protocol conditionally approved by FDA July 26, 2012
49 COAPT Inclusion Symptomatic functional MR ( 3+) Cardiomyopathy ischemic or non-ischemic LVEF 20% and 50% HF hospitalization 12 months and/or a corrected BNP 300 pg/ml or NT-proBNP 1500 pg/ml 90 days TTE on optimal therapy 30 days after: any change in GDMT revascularization and/or implant of CRT Version 5.1 November 11, 2013
50 Case History 79 year old man s/p prior CABG with a 6 month history of refractory CHF and severe MR, despite maximum medical therapy. No LBBB. Several comorbidities including Creatinine or 2.0 mg/dl, atrial fibrillation, DM, prior CVA (complete recovery) Echo revealed 4+ MR caused by functional valve disease and EF of 25%; turned down by two surgeons
51 Baseline Echo: FMR
52 MitraClip Placement
53 Follow Up Single Clip
54 Follow Up Trace MR after one clip Device time 43 min Home the following day No rehospitalizations 2 Year follow up EF 30-35% with mild 1+ MR; Functional Class II
55 Follow Up Echo
56 Outline Introduction Transcatheter Repair MitraClip Annular Approaches TMVR Summary/Conclusions
57 Percutaneous Mitral Repair Devices Already gone PTMA Monarc Mobuis leaflet repair Recor RF annular remodeling Coapsys Still developing Leaflet repair CS annuloplasty Direct annuloplasty Cerclage Mitral spacer Midle Peak Chordal replacement Valve replacement
58 Coronary Sinus- Indirect Annuloplasty CARILLON Mitral Contour System
59
60 TITAN Trial CARILLON Mitral ystem for FunContour Sctional MR 40% reduction in MR Reverse remodeling Functional improvement Implanted Non-Implanted n=36 n=17 Eur J Heart Fail Aug;14(8):931-8
61
62 Update from European CARDIOBAND Trial 35 patients results 2/3/2015 Septo Lateral Dimension 24/33 Patients with MR Mild at 6 Months FU Mean Age 72 (56-81) STS Repair 7 (1-34)
63 DIRECT ANNULOPLASTY Mitralign Procedure Steps Wire Delivery Pledget Delivery Plication & Lock
64 Direct Annuloplasty - Transventricular Approach Mitralign System Wire Placement Pledget Delivery
65 CE Mark Study 30-Day Performance: Core Lab Adjudicated Ventricular Changes Baseline (n) 30 Day (n) 30 Day Change Paired (n) 30 Day Change P-Value LVIDd (cm) 6.35 (44) 6.10 (38) (36) LVIDs (cm) 5.37 (44) 5.15 (38) (35) LVEDv (ml) (44) (38) (31) < LVESv (ml) (44) (38) (31) Annular Changes Baseline (n) 30 Day (n) 30 Day Paired Change (n) P-Value A-P Dia. (cm) 3.58 (44) 3.27 (38) (31) < S-L Dia. (cm) 3.55 (44) 3.34 (38) (33) < N=64 Investigational Device Only: Not Available in the EU or US
66 .J Am Coll Cardiol. 2015;65:1190 5
67 Suture bicuspidization of the tricuspid valve vs ring annuloplasty for functional tricuspid regurgitation Midterm results of 237 consecutive patients Kay bicuspidization procedure Suture bicuspidization is performed by placement of a 2-0 pledget-supported mattress suture from the antero-posterior to the posteroseptal commissures along the posterior annulus. J Thorac Cardiovasc Surg 2007;133:
68 Schofer et al. J Am Coll Cardiol. 2015;65:1190 5
69 JAmCollCardiol2015;65: First Human Report on Percutaneous Repair for Functional Tricuspid Regurgitation with the Mitralign System Schofer et al. J Am Coll Cardiol. 2015;65:1190 5
70 Outline Introduction Transcatheter Repair MitraClip Annular Approaches TMVR Summary/Conclusions
71 Mitral Replacement Technologies CardiaAQ Neovasc TIARA Tendyne Edwards FORTIS Endovalve M-Valve Medtronic Valtech Lutter MitrAssist Caisson MitraSeal Twelve HighLife Others.
72 Mitral Replacement FIRSTS IN HUMAN CardiaAQ 2012 Tendyne implants 2013 Temp Neovasc Tiara January 2014 Edwards FORTIS February 2014
73 Transcatheter mitral valve implantation (TMVI) using the Edwards FORTIS device Bapat V: EuroIntervention 2014;10:U120-U128
74
75
76
77 Outline Introduction Transcatheter Repair MitraClip Annular Approaches TMVR Summary/Conclusions
78 Conclusion Unmet need in high risk patients with MR MitraClip safe and effective Less MR reduction than surgical repair Approved in US for high surgical-risk patients with degenerative MR >80% have <2+ MR, short hospital duration, fewer repeat hospitalizations, favorable LV remodeling and functional/qol outcomes Functional MR enroll in COAPT Annular approaches Early TMVR even earlier - Infancy
79 Thanks for your attention!
Percutaneous Mitral Valve Repair
Percutaneous Mitral Valve Repair MitraClip: Procedure, Data, Patient Selection Chad Rammohan, MD FACC Director, Cardiac Cath Lab El Camino Hospital Mountain View, California Mitral Regurgitation MitraClip
Current status: Percutaneous mitral valve therapy
Current status: Percutaneous mitral valve therapy Ted Feldman, M.D., FSCAI FACC FESC Evanston Hospital ESC Stockholm 2010 Disclosures Research Grants Abbott, Edwards Consultant Abbott, Edwards 2 Percutaneous
Disclosure Statement of Financial Interest Saibal Kar, MD, FACC
MitraClip Therapy Saibal Kar, MD, FACC, FAHA, FSCAI Director of Interventional Cardiac Research Program Director, Interventional Cardiology Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
Percutaneous Therapy for Mitral Regurgitation: Current and Future Options: Could we do better today?
Percutaneous Therapy for Mitral Regurgitation: Current and Future Options: Could we do better today? Peter S. Fail, MD, FACC, FACP, FSCAI Director of the Cardiac Catheterization Laboratories and Interventional
Status Of The MitraClip: Trials (EVEREST II & COAPT) & FDA
Status Of The MitraClip: Trials (EVEREST II & COAPT) & FDA Ted Feldman, M.D., FSCAI FACC FESC Evanston Hospital SCAI Fall Fellows Course Las Vegas, Nevada December 8 11 th, 2013 Ted Feldman MD, FACC, FESC,
Percutaneous mitral valve repair: current techniques and results
Percutaneous mitral valve repair: current techniques and results Ted Feldman, M.D., FSCAI, FACC Angioplasty Summit April 25-27 th th 2007 Seoul, Korea Ted Feldman MD, FACC, FSCAI Disclosure Information
Percutaneous Mitral Valve Repair: What Can We Treat and What Should We Treat
Percutaneous Mitral Valve Repair: What Can We Treat and What Should We Treat Innovative Procedures, Devices & State of the Art Care for Arrhythmias, Heart Failure & Structural Heart Disease October 8-10,
Eulogio Garcia MD Hospital Clínico San Carlos Madrid - Spain
Eulogio Garcia MD Hospital Clínico San Carlos Madrid - Spain Device Landscape 2010 PERCUTANEOUS TECHNIQUES Percutaneous indirect annuloplasty Percutaneous direct annuloplasty Edge to Edge ( E-Valve ) Non
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
Percutaneous Mitral Valve Repair
Indiana Chapter of ACC November 15 th,2008 Percutaneous Mitral Valve Repair James B Hermiller, MD, FACC The Care Group, LLC St Vincent Hospital Indianapolis, IN Mechanisms of Mitral Regurgitation Mitral
Prognostic Impact of FMR
Secondary Mitral Valve Regurgitation in Heart Failure, Age 60 Years From Medical Therapy to Surgical Repair to Transcatheter Intervention The Interventionalist s View Samin K Sharma, MD, FACC, FSCAI Director
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
Outline 9/17/2016. Advances in Percutaneous Mitral Valve Repair and Replacement. Scope of the Problem and Guidelines
Advances in Percutaneous Mitral Valve Repair and Replacement Scott M Lilly MD PhD, Interventional Cardiology The Ohio State University Contemporary Multidisciplinary Cardiovascular Conference Orlando,
GDMT for percutaneous mitral valve repair
GDMT for percutaneous mitral valve repair Ted Feldman, M.D., MSCAI FACC FESC Evanston Hospital The 11th Annual Innovations & Trends in Cardiovascular Care New Brunswick, NJ October 18 th 2014 Ted Feldman
Percutaneous mitral valve repair/replacement. Jan Van der Heyden MD, PhD St.Antonius Hospital Nieuwegein
Percutaneous mitral valve repair/replacement Jan Van der Heyden MD, PhD St.Antonius Hospital Nieuwegein Mitral Valve anatomy Difference between AoV and MV Aortic Valve Mitral Valve Transcatheter Mitral
TREATMENT OF MITRAL REGURGITATION RAJA NAZIR FACC
TREATMENT OF MITRAL REGURGITATION RAJA NAZIR FACC NATURAL HISTORY OF MITRAL REGURGITATION Abdallah El Sabbagh et al. JIMG 2018;11:628-643 TREATMENT OPTIONS SURGERY REPAIR REPLACEMENT PERCUTANEOUS INTERVENTIONS
Percutaneous Repair for MR:
Percutaneous Repair for MR: Follow-up and longer term outcomes Ted Feldman, M.D., FSCAI FACC FESC Evanston Hospital 16th ANGIOPLASTY SUMMIT TCT Asia Pacific 2011 April 27-29 th Seoul, Korea Ted Feldman
PERCUTANEOUS MITRAL VALVE THERAPIES 13 TH ANNUAL CARDIAC, VASCULAR AND STROKE CARE CONFERENCE PIEDMONT ATHENS REGIONAL
PERCUTANEOUS MITRAL VALVE THERAPIES 13 TH ANNUAL CARDIAC, VASCULAR AND STROKE CARE CONFERENCE PIEDMONT ATHENS REGIONAL DISCLOSURES I WILL BE DISCUSSING OFF-LABEL USAGE OF DEVICES RELATED TO TMVR OBJECTIVES
Introducing the COAPT Trial
physician INFORMATION Eligible patients Symptomatic functional mitral regurgitation 3+ Not suitable candidates for open mitral valve surgery NYHA functional class II, III, or ambulatory IV Introducing
Transcatheter Mitral Innovations, Part II. Michael Mack, M.D. Baylor Scott & White Health
Transcatheter Mitral Innovations, Part II Michael Mack, M.D. Baylor Scott & White Health Conflict of Interest Disclosure Co-PI of the COAPT Trial of MitraClip sponsored by Abbott Vascular Uncompensated
Transcatheter Mitral Valve Interventions: Clinical Indications. Didier TCHETCHE, MD. Clinique Pasteur, Toulouse, France.
Transcatheter Mitral Valve Interventions: Clinical Indications Didier TCHETCHE, MD. Clinique Pasteur, Toulouse, France. Conflicts of interest: -Consultant for Medtronic -Consultant for Cephea Anatomy of
Transcatheter Mitral Valve Repair and Replacement: Where is the Latest Randomized Evidence Taking US Mitral-Fr, COAPT
Transcatheter Mitral Valve Repair and Replacement: Where is the Latest Randomized Evidence Taking US Mitral-Fr, COAPT and Saibal Kar, MD, FACC, FSCAI Professor of Medicine Director of Interventional Cardiac
Mitral Regurgitation
Mitral Regurgitation Focus on Percutaneous Repair Steven J. Yakubov, MD FACC FSCAI System Chief, Structural Heart Diseaese, OhioHealth John H. McConnell Chair of Advanced Structural Heart Disease Medical
Τελικά επιδιόρθωση, αντικατάσταση ή clip στην ισχαιμική ανεπάρκεια Μιτροειδούς; ΒΛΑΣΗΣ ΝΙΝΙΟΣ MD MRCP ΚΛΙΝΙΚΗ ΑΓΙΟΣ ΛΟΥΚΑΣ
Τελικά επιδιόρθωση, αντικατάσταση ή clip στην ισχαιμική ανεπάρκεια Μιτροειδούς; ΒΛΑΣΗΣ ΝΙΝΙΟΣ MD MRCP ΚΛΙΝΙΚΗ ΑΓΙΟΣ ΛΟΥΚΑΣ Carpentier MV Classification- Leaflet Mobility Normal Increased Decreased Mobility
Reshape/Coapt: do we need more? Prof. J Zamorano Head of Cardiology University Hospital Ramon y Cajal, Madrid
Reshape/Coapt: do we need more? Prof. J Zamorano Head of Cardiology University Hospital Ramon y Cajal, Madrid Patient records 76 y.o. male Hypertension. Dyslipidemia. OPLD. Smoked in the past. Diabetes
Percutaneous Mitral Valve Therapies
Percutaneous Mitral Valve Therapies Jeffrey J. Popma, MD Director, Interventional Cardiology Clinical Services Beth Israel Deaconess Medical Center Associate Professor of Medicine Harvard Medical School
Mitral Valve Disease, When to Intervene
Mitral Valve Disease, When to Intervene Swedish Heart and Vascular Institute Ming Zhang MD PhD Interventional Cardiology Structure Heart Disease Conflict of Interest None Current ACC/AHA guideline Stages
Chapter 24: Diagnostic workup and evaluation: eligibility, risk assessment, FDA guidelines Ashwin Nathan, MD, Saif Anwaruddin, MD, FACC Penn Medicine
Chapter 24: Diagnostic workup and evaluation: eligibility, risk assessment, FDA guidelines Ashwin Nathan, MD, Saif Anwaruddin, MD, FACC Penn Medicine Mitral regurgitation, regurgitant flow between the
SURGICAL AND TRANSCATHETER MITRAL VALVE REPLACEMENT VS. REPAIR: COMPETITION OR SYNERGY
SURGICAL AND TRANSCATHETER MITRAL VALVE REPLACEMENT VS. REPAIR: COMPETITION OR SYNERGY Michael J. Reardon, M.D. Professor of Cardiothoracic Surgery Allison Family Distinguish Chair of Cardiovascular Research
Emerging Mitral Technologies Where Are We Now? MICHAEL MACK, MD BAYLOR SCOTT & WHITE HEALTH DALLAS, TX
Emerging Mitral Technologies Where Are We Now? MICHAEL MACK, MD BAYLOR SCOTT & WHITE HEALTH DALLAS, TX Conflict of Interest Disclosure Abbott Vascular- Co PI COAPT Trial Medtronic- Executive Committee
Outcomes of the Initial Experience with Commercial Transcatheter Mitral Valve Repair in the U.S.
ACC 2015 LBCT Outcomes of the Initial Experience with Commercial Transcatheter Mitral Valve Repair in the U.S. A report from the STS/ACC TVT Registry Paul Sorajja, MD, Saibal Kar, MD, Amanda Stebbins,
Valvular Intervention
Valvular Intervention Outline Introduction Aortic Stenosis Mitral Regurgitation Conclusion Calcific Aortic Stenosis Deformed Eccentric Calcified Nodular Rigid HOSTILE TARGET difficult to displace prone
CLIP ΜΙΤΡΟΕΙ ΟΥΣ: ΠΟΥ ΒΡΙΣΚΟΜΑΣΤΕ;
CLIP ΜΙΤΡΟΕΙ ΟΥΣ: ΠΟΥ ΒΡΙΣΚΟΜΑΣΤΕ; Επιµορφωτικά Σεµινάρια Ειδικευοµένων Καρδιολογίας 7 Απριλίου 2012 M Chrissoheris MD FACC THV Department HYGEIA Hospital Degenerative MR (DMR) Usually refers to an anatomic
Percutaneous mitral annuloplasty. Francesco Maisano MD, FESC San Raffaele Hospital Milano, Italy
Percutaneous mitral annuloplasty Francesco Maisano MD, FESC San Raffaele Hospital Milano, Italy Disclosure Consultant for Abbott, Medtronic, St Jude, Edwards, ValtechCardio Founder of 4Tech Surgical techniques
Contemporary Management of Mitral Regurgitation Tailoring Treatment to The Patient Subset & Clinical Situation
Contemporary Management of Mitral Regurgitation Tailoring Treatment to The Patient Subset & Clinical Situation Hatim Al Lawati MD, FRCPC, FACC Consultant Interventional Cardiology Sultan Qaboos University
Update on Transcatheter Mitral Valve Repair and Replacment
Update on Transcatheter Mitral Valve Repair and Replacment Vinod H. Thourani, MD Professor of Surgery Chair, Department of Cardiac Surgery Medstar Heart and Vascular Washington Hospital Center Georgetown
Transcatheter Mitral Valve Repair: today and tomorrow Sponsored by Abbott. Chairperson: M. Haude Panellists: A. Al Nooryani, M.
Transcatheter Mitral Valve Repair: today and tomorrow Sponsored by Abbott Chairperson: M. Haude Panellists: A. Al Nooryani, M. Al Otaiby Session objectives To learn about the clinical patient profile for
Next Generation Therapies: Aortic, Mitral and Beyond
Next Generation Therapies: Aortic, Mitral and Beyond Scott M Lilly, MD PhD Medical (Interventional) Director, Structural Heart Program Heart Summit, Lima OH August 26 th, 2017 Next Generation Therapies:
Who will Benefit from Percutaneous Management of Mitral Regurgitation? An Imaging Guide to Management
Who will Benefit from Percutaneous Management of Mitral Regurgitation? An Imaging Guide to Management James D. Thomas, M.D., F.A.C.C. Department of Cardiovascular Medicine Heart and Vascular Institute
Minimally invasive therapies for the mitral valve: How will you incorporate into your clinical practice? Guilherme F.
Minimally invasive therapies for the mitral valve: How will you incorporate into your clinical practice? Guilherme F. Attizzani, MD UH Harrington Heart and Vascular Institute Interventional Cardiologist/Structural
The Mitral Revolution: Transcatheter Repair (and Replacement?) Going Mainstream
The Mitral Revolution: Transcatheter Repair (and Replacement?) Going Mainstream Matthew J. Price MD Director, Cardiac Catheterization Laboratory Scripps Clinic La Jolla, CA, USA price.matthew@scrippshealth.org
Transcatheter Mitral Valve for fmr: The Era of Too Many Options
Transcatheter Mitral Valve for fmr: The Era of Too Many Options Isaac George, M.D. Surgical Director, Structural Heart & Valve Center Assistant Professor of Surgery Columbia University Medical Center Disclosure
Repair or Replacement
Surgical intervention post MitraClip Device: Repair or Replacement Saudi Heart Association, February 21-24 Rüdiger Lange, MD, PhD Nicolo Piazza, MD, FRCPC, FESC German Heart Center, Munich, Germany Division
Get Ready for Percutaneous Mitral Valve Approaches
Get Ready for Percutaneous Mitral Valve Approaches Paul A. Grayburn, MD Baylor Scott and White Healthcare System The Heart Hospital Baylor Plano and Baylor Heart and Vascular Hospital Dallas, TX HOPE Unmet
Mitral regurgitation (MR) is the second most
Current Options for Mitral Annuloplasty and Leaflet Repair The benefits and limitations of today s FDA- and CE Mark approved mitral repair technologies. BY ROBERT SCHUELER, MD, AND JAN-MALTE SINNING, MD,
ΔΙΑΔΕΡΜΙΚΗ ΑΝΤΙΜΕΤΩΠΙΣΗ ΔΟΜΙΚΩΝ ΠΑΘΗΣΕΩΝ: Ο ΡΟΛΟΣ ΤΗΣ ΑΠΕΙΚΟΝΙΣΗΣ ΣΤΟ ΑΙΜΟΔΥΝΑΜΙΚΟ ΕΡΓΑΣΤΗΡΙΟ ΣΤΗΝ ΤΟΠΟΘΕΤΗΣΗ MITRACLIP
ΔΙΑΔΕΡΜΙΚΗ ΑΝΤΙΜΕΤΩΠΙΣΗ ΔΟΜΙΚΩΝ ΠΑΘΗΣΕΩΝ: Ο ΡΟΛΟΣ ΤΗΣ ΑΠΕΙΚΟΝΙΣΗΣ ΣΤΟ ΑΙΜΟΔΥΝΑΜΙΚΟ ΕΡΓΑΣΤΗΡΙΟ ΣΤΗΝ ΤΟΠΟΘΕΤΗΣΗ MITRACLIP ΒΛΑΣΗΣ ΝΙΝΙΟΣ MD MRCP ΚΛΙΝΙΚΗ ΑΓΙΟΣ ΛΟΥΚΑΣ ΘΕΣΣΑΛΟΝΙΚΗ CONFLICT OF INTEREST PROCTOR
Percutaneous Treatment of Mitral Insufficiency: Present and Future
Percutaneous Treatment of Mitral Insufficiency: Present and Future Larry S. Dean, MD, MSCAI Past President SCAI Professor of Medicine and Surgery University of Washington School of Medicine Seattle, WA
Index. B B-type natriuretic peptide (BNP), 76
Index A ACCESS-EU registry, 158 159 Acute kidney injury (AKI), 76, 88 Annular enlargement, RV, 177 178 Annuloplasty chordal cutting, 113 complete ring, 99 etiology-specific ring, 100 evolution, 98 flexible
Steven F Bolling Professor of Cardiac Surgery University of Michigan
Optimal Treatment of Functional MR Steven F Bolling Professor of Cardiac Surgery University of Michigan Functional MR Functional MR in Ischemia Badhwar, Bolling, chapter in: Advances in Heart Failure,
TrattamentoTrans-catetere dell insufficienza mitralica. Francesco Bedogni. Istituto Clinico S. Ambrogio, Milano
TrattamentoTrans-catetere dell insufficienza mitralica Francesco Bedogni Severe MR Leads to Increased Hospital Admissions and Lower Survival Rates Significantly higher hospital admissions experienced by
Transcatheter Mitral Valve Implantation: Techniques and Early Clinical Outcomes. Dr. T. Modine MD, PhD, MBA Heart team CHRU de Lille
Transcatheter Mitral Valve Implantation: Techniques and Early Clinical Outcomes Dr. T. Modine MD, PhD, MBA Heart team CHRU de Lille Speaker's name: Thomas Modine I have the following potential conflicts
Transcatheter Mitral & Tricuspid Therapies. Bernard J. Zovighian Corporate Vice President
Transcatheter Mitral & Tricuspid Therapies Bernard J. Zovighian Corporate Vice President We Will Lead and Transform Treatment for Patients with Mitral and Tricuspid Diseases Mitral and Tricuspid Diseases
Understanding the guidelines for Interventions in MR. Ali AlMasood
Understanding the guidelines for Interventions in MR Ali AlMasood Mitral regurgitation The most diverse from all acquired valve diseases About 50% of patients with an LVEF 35 percent had moderate to severe
Advanced Mitral Valve Therapies
Advanced Mitral Valve Therapies Mahesh Ramchandani MD, FRCS Chief, Section of Cardiac Surgery A Largely Untreated Patient Population Mitral Regurgitation 2009 U.S. Prevalence Total MR Patients 1,2 4,100,000
MITRAL (Mitral Implantation of TRAnscatheter valves)
MITRAL (Mitral Implantation of TRAnscatheter valves) 30-Day Outcomes of Transcatheter MV Replacement in Patients With Severe Mitral Valve Disease Secondary to Mitral Annular Calcification or Failed Annuloplasty
Professor and Chief, Division of Cardiac Surgery Chief Medical Officer, Harpoon Medical. The Houston Aortic Symposium February 23-25, 2017
James S. Gammie, MD Professor and Chief, Division of Cardiac Surgery Chief Medical Officer, Harpoon Medical The Houston Aortic Symposium February 2-25, 2017 Disclosure Statement of Financial Interest Within
The FORMA Early Feasibility Study: 30-Day Outcomes of Transcatheter Tricuspid Valve Therapy in Patients with Severe Secondary Tricuspid Regurgitation
The FORMA Early Feasibility Study: 30-Day Outcomes of Transcatheter Tricuspid Valve Therapy in Patients with Severe Secondary Tricuspid Regurgitation Susheel Kodali, MD Director, Structural Heart & Valve
William A. Gray MD System Chief of Cardiovascular Services, Main Line Health President, Lankenau Heart Institute Wynnewood, Pennsylvania USA
William A. Gray MD System Chief of Cardiovascular Services, Main Line Health President, Lankenau Heart Institute Wynnewood, Pennsylvania USA Mitral Valve Disease Today Mitral regurgitation is the most
Conflict of Interests
Introduction to Interventional Echocardiography Roberto M Lang, MD Tomtec Conflict of Interests Research Grants Philips Medical Imaging Research Grants Speakers bureau Advisory bureau 1 Structural Heart
Burden of Mitral Regurgitation (MR) in the US Why is This Important?
Secondary (Functional) Mitral Regurgitation as a Target for Heart Failure Therapy William T. Abraham, MD, FACP, FACC, FAHA, FESC, FRCP Professor of Medicine, Physiology, and Cell Biology Chair of Excellence
VALVULOPATIE: NUOVE SOLUZIONI.
VALVULOPATIE: NUOVE SOLUZIONI www.fisiokinesiterapia.biz Nkomo, Lancet 2006 ELDERLY POPULATION PROJECTION IN USA 65-84 Years Old 85 and Older 77,2 Millions of people 34,8 4,3 30,5 53,8 6,8 47 14,3 62,9
Management of Secondary MR : Insights from CTSN Ischemic MR trial; COAPT and MITRA-FR:
Management of Secondary MR : Insights from CTSN Ischemic MR trial; COAPT and MITRA-FR: Saibal Kar, MD, FACC, FSCAI Professor of Medicine Director of Interventional Cardiac Research Smidt Heart Institute,
Mitral Regurgitation Epidemiology and Classification
Subject: Transcatheter Mitral Valve Repair Page: 1 of 23 Last Review Status/Date: December 2015 Transcatheter Mitral Valve Repair Description Transcatheter mitral valve repair is a potential alternative
Organic mitral regurgitation
The best in heart valve disease Organic mitral regurgitation Ewa Szymczyk Department of Cardiology Medical University of Lodz, Poland I have nothing to declare Organic mitral regurgitation leaflet abnormality
Percutaneous Transcatheter Treatment of Valvular Disease TAVR and Beyond
Percutaneous Transcatheter Treatment of Valvular Disease TAVR and Beyond CREIGHTON W. DON, MD, PHD ASSOCIATE PROFESSOR OF MEDICINE DIRECTOR, INTERVENTIONAL AND STRUCTURAL HEART FELLOWSHIPS DIVISION OF
MitraClip in the ICCU: Which Patient will Benefit?
MitraClip in the ICCU: Which Patient will Benefit? DAVID MEERKIN STRUCTURAL A ND CONGENITAL HEART DISEASE UNIT SHAARE ZEDEK MEDICAL CENTER JERUSALEM Conflict of Interest No relevant disclosures Complex
MitraClip World Wide Commercial Experience
MitraClip World Wide Commercial Experience Valves Repaired. Lives Improved. Carlos G. Hernandez, MBA Sr. Product Manager, Strategic Planning Abbott Vascular October, 2014 MitraClip Transcatheter Mitral
Transcatheter mitral valve repair is considered investigational in all situations.
2.02.30 Transcatheter Mitral Valve Repair Section 2.0 Medicine Subsection 2.02 Cardiology Description Effective Date September 30, 20114 Original Policy Date September 30, 2014 Next Review Date September
ACCESS-EUROPE Phase I
ACCESS-EUROPE Phase I A Post Market Study of the MitraClip System for the Treatment of Significant Mitral Regurgitation in Europe: Analysis of Outcomes at 1 Year Wolfgang Schillinger, MD on behalf of the
APOLLO TMVR Trial Update: Case Presentation
APOLLO TMVR Trial Update: Case Presentation Anelechi Anyanwu, MD, MSc, FRCS-CTh Professor and Vice-Chairman Department of Cardiovascular Surgery Icahn School of Medicine at Mount Sinai New York, NY Disclosure
Percutaneous Treatment of Valvular Heart Diseases: Lessons and Perspectives. Bernard Iung Bichat Hospital, Paris
Percutaneous Treatment of Valvular Heart Diseases: Lessons and Perspectives Bernard Iung Bichat Hospital, Paris Euro Heart Survey on Valvular Diseases 3547 Patients with Native Valve Disease n= 1250 1000
8/31/2016. Mitraclip in Matthew Johnson, MD
Mitraclip in 2016 Matthew Johnson, MD 1 Abnormal Valve Function Valve Stenosis Obstruction to valve flow during that phase of the cardiac cycle when the valve is normally open. Hemodynamic hallmark - pressure
When is it too late to perform transcatheter mitral valve repair? Alec Vahanian, FESC,FRCP(Edin.) Bichat hospital University Paris VII
When is it too late to perform transcatheter mitral valve repair? Alec Vahanian, FESC,FRCP(Edin.) Bichat hospital University Paris VII I, (Alec Vahanian) DO have a financial interest/arrangement or affiliation
Functional Mitral Regurgitation; therapeutic continuum overview. Michele Senni. Cardiologia 1 Scompenso e Trapianti di Cuore A.O. PAPA GIOVANNI XXIII
Functional Mitral Regurgitation; therapeutic continuum overview Michele Senni Cardiologia 1 Scompenso e Trapianti di Cuore A.O. PAPA GIOVANNI XXIII Functional Mitral Regurgitation FMR is not the result
Index. interventional.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Ablation, of mitral leaflets, 80 Accucinch Annuloplasty system, for mitral regurgitation, 79, 94 95 Accutrak delivery system, for CoreValve
Euro Heart Survey New Programme Sentinel Registry Transcatheter Valve Treatment (TCVT) Carlo Di Mario, London, UK President EAPCI
Euro Heart Survey New Programme 2009-2012 Sentinel Registry Transcatheter Valve Treatment (TCVT) Carlo Di Mario, London, UK President EAPCI Alan Cribier, Rouen, France Andreas Gruentzig Award 2010 Cardiogenic
Transcatheter Mitral Valve Replacement How Close Are We?
Transcatheter Mitral Valve Replacement How Close Are We? Gregory Pavlides, MD, PhD, FACC, FESC Professor of Medicine Miscia Chair of Interventional Cardiology Director, Cardiac Catheterization Laboratories,
Use of MitraClip Beyond Everest Criteria
Use of MitraClip Beyond Everest Criteria Takashi Matsumoto, MD Sendai Kousei Hospital Sendai, Japan No Disclosure of Financial Interest Introduction The efficacy and safety of the MitraClip therapy was
Health Status after Transcatheter Mitral- Valve Repair in Patients with Heart Failure and Secondary Mitral Regurgitation: Results from the COAPT Trial
Health Status after Transcatheter Mitral- Valve Repair in Patients with Heart Failure and Secondary Mitral Regurgitation: Results from the COAPT Trial Suzanne V. Arnold, MD, MHA Saint Luke s Mid America
What Is the Role of Mitral Repair in Heart Failure?
ASK THE EXPERTS What Is the Role of Mitral Repair in Heart Failure? Experts discuss treatment strategies for patients with mitral regurgitation progressing to heart failure. WITH WILLIAM WEIR, MD; STEPHEN
Treatment options in ischaemic mitral regurgitation: surgery, clips, devices?
Treatment options in ischaemic mitral regurgitation: surgery, clips, devices? Francisco Leyva Conflicts of interest: FL has received advisory board fees from Medtronic Inc, Sorin, St Jude Medical and Abbot.
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,
Valvular Heart Disease Transcatheter Valve Therapies. October 2016 Brian Whisenant MD
Valvular Heart Disease Transcatheter Valve Therapies October 2016 Brian Whisenant MD Disclosure Statement of Financial Interest Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement
Mitral valve treatment in advanced heart failure: Repair, Replacement, MitraClip. Nicola Buzzatti, MD San Raffaele Scientific Institute Milan, Italy
Mitral valve treatment in advanced heart failure: Repair, Replacement, MitraClip Nicola Buzzatti, MD San Raffaele Scientific Institute Milan, Italy Disclosures I have nothing to disclose FMR: a ventricular
Really Less-Invasive Trans-apical Beating Heart Mitral Valve Repair: Which Patients?
Really Less-Invasive Trans-apical Beating Heart Mitral Valve Repair: Which Patients? David H. Adams, MD Cardiac Surgeon-in-Chief Mount Sinai Health System Marie Josée and Henry R. Kravis Professor and
Watchman and Structural update..the next frontier. Ari Chanda, MD Cardiology Associates of Fredericksburg
Watchman and Structural update..the next frontier Ari Chanda, MD Cardiology Associates of Fredericksburg Different Left Atrial Appendage (LAA) morphologies Watchman (the device) Fabric Anchors Device structure
Ian T. Meredith AM. MBBS, PhD, FRACP, FCSANZ, FACC, FAPSIC. Monash HEART, Monash Health & Monash University Melbourne, Australia
Two-Year Outcomes With the Fully Repositionable and Retrievable Lotus Transcatheter Aortic Replacement Valve in 120 High-Risk Surgical Patients With Severe Aortic Stenosis: Results From the REPRISE II
Latest therapies for patients with HF. Dr AIGUL BALTABAEVA PhD, FESC, FRCP RBHT & ASPH
Latest therapies for patients with HF Dr AIGUL BALTABAEVA PhD, FESC, FRCP RBHT & ASPH ESC HF Guidelines 2016 ESC HF Guidelines 2016: Pharmacological Treatments Pathways blocked by ACE-I, ARB and NI Effect
Update on Percutaneous Therapies for Structural Heart Disease. William Thomas MD Director of Structural Heart Program Tucson Medical Center
Update on Percutaneous Therapies for Structural Heart Disease William Thomas MD Director of Structural Heart Program Tucson Medical Center NCVH 2014- Tucson Disclosure of Financial Interest Research: Stock
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
Sergio Berti Ospedale del Cuore Fondazione C.N.R. Reg Toscana Massa/Pisa
Sergio Berti Ospedale del Cuore Fondazione C.N.R. Reg Toscana Massa/Pisa Prevalence of Valvular Disease The Lancet, Vol. 368, Nkomo, V. T. et al., Burden of valvular heart diseases: a population-based
Χειρουργική Αντιμετώπιση της Ανεπάρκειας της Μιτροειδούς Βαλβίδας
Χειρουργική Αντιμετώπιση της Ανεπάρκειας της Μιτροειδούς Βαλβίδας Dr Χρήστος ΑΛΕΞΙΟΥ MD, PhD, FRCS(Glasgow), FRCS(CTh), CCST(UK) Consultant Cardiothoracic Surgeon Normal Mitral Valve Function Mitral Regurgitation
Valve Technology. Sheath Compatibility. Available Valve Sizes. Pre-procedural Severity of AS, cusp anatomy, annular size, vascular access 21 mm
Guidance of Valvular Interventions Percutaneous Approaches to Aortic and Mitral Valve Disease James D. Thomas, MD, FACC, FASE Director, Center for Heart Valve Disease Bluhm Cardiovascular Institute Professor
NON SURGICAL TREATMENT OF CARDIAC DISEASE PETER J SABIA, MD FACC ASSOCIATES IN CARDIOLOGY SILVER SPRING, MARYLAND
NON SURGICAL TREATMENT OF CARDIAC DISEASE PETER J SABIA, MD FACC ASSOCIATES IN CARDIOLOGY SILVER SPRING, MARYLAND TOPICS ATRIAL SEPTAL DEFECT VSD IHSS PERCUTANEOUS AORTIC VALVE PERCUTANEOUS MITRAL VALVE
Aortic Stenosis and TAVR TARUN NAGRANI, MD INTERVENTIONAL AND ENDOVASCULAR CARDIOLOGIST, SOMC
Aortic Stenosis and TAVR TARUN NAGRANI, MD INTERVENTIONAL AND ENDOVASCULAR CARDIOLOGIST, SOMC No Financial Disclosures Aortic Stenosis AS is an insidious disease with a long latency period followed by
Development of a TMVR Device Challenge to Innovators
Development of a TMVR Device Challenge to Innovators Eberhard Grube MD, FACC, FSCAI, FAPSIC University Bonn, Heart Center, Bonn, Germany Stanford Universuty, School of Medicine, Palo Alto, CA Disclosure
Edwards' solution for patients suffering from tricuspid valve disease
Edwards' solution for patients suffering from tricuspid valve disease R. S. von Bardeleben, MD Head Structural and Heart Valve Center Heart Center Cardiology I, University Medicine Mainz Germany Potential
Percutaneous Tricuspid Valve Therapies: The Next Frontier? Is the Tricuspid Valve Relevant? Data and Guidelines for TV Interventions
Percutaneous Tricuspid Valve Therapies: The Next Frontier? Scott M Lilly, MD PhD The Ohio State University Structural Heart Disease Course May 19 th, 2017 Outline Is the Tricuspid Valve Relevant? Data
Interventional Updates 2016
nterventional Updates 2016 Matthew Johnson, MD Dual Antiplatelet Therapy (DAPT ) What is the newest. Can they ever make up there minds???? What is new in the world of TAVR 1 New risk MitraClip getting
Percutaneous Mitral Valve Repair
Percutaneous Mitral Valve Repair Policy Number: Original Effective Date: MM.06.027 08/01/2015 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 08/01/2017 Section: Surgery Place(s)