Transcatheter Mitral Valve Replacement. Lutter G, Lozonschi L
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1 Transcatheter Mitral Valve Replacement Lutter G, Lozonschi L Department of Cardiovascular Surgery University Hospital, Campus Kiel, Germany and Division of Cardiothoracic Surgery, University of Wisconsin, Madison, USA
2 Speaker s name: Lutter UNIVERSITÄTSKLINIKUM Potential conflicts of interest X I have the following potential conflicts of interest to report: Research contracts X Consulting for TENDYNE INC, Baltimore, USA Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest
3 Percutaneous techniques for mitral reconstruction Technology Approach Edge-to-Edge Abbot Vascular Edwards Double Orifice Coronary Sinus Edwards Cardiac Dimensions CS Reshaping Annulus Plication Mitralign Guided Delivery Systems Posterior Reshaping LV Dimension Change Mitralign Myocor External LA / LV Septal lateral shortening Ample Medical Inc. External LA / LV
4 Surgical minimally-invasive mitral tools Alfieri, Maisano et al., EJCTS 2011 Dept. of Cardiovascular Surgery
5 Percutaneous mitral valved stent implantation Ma L, Tozzi P, Huber C.H, et al. Double-crowned valved stents for off-pump mitral valve replacement.eur J Cardio-thoracic Surg 28 (2005) Ma L, Huber C et al. EJCTS 2005
6 Percutaneous mitral valved stent implantation
7 Percutaneous mitral valved stent implantation Dept. of Cardiovascular Surgery
8 UNIVERSITÄTSKLINIKUM
9 TIARA VALVE Tel Aviv, Israel
10 Mitral valve
11
12 Conception Lutter G, Marczynski-Bühlow M, Pokorny S, Lozonschi L
13 Transapical mitral valved stent implantation Electropolished, radially self-expanding valved stent Atrial fixation system connected at 45 Tubular portion with bovine pericadial valve (28 mm) Ventricular fixation system Catheter based delivery system (10.5 mm) Lutter G, Lozonschi L, Cremer J J Thorac Cardiovasc Surg. 2010
14 Experimental mid-term study 6 pigs ( Kg) Transapical approach, off-pump Evaluation : at 60 minutes (n=6) at 4 weeks (n = 4) at 8 weeks (n = 1) TEE, contrast ventriculography, CT Lutter G, Lozonschi L, Cremer J J Thorac Cardiovasc Surg. 2010
15 Überschrift Normaler Text Aufzählung Lutter G, Lozonschi L et al. Dept. of Cardiovascular Surgery
16 Minimally invasive apical approach Lutter G, Lozonschi L, Cremer J J Thorac Cardiovasc Surg. 2010
17 Überschrift Normaler Text Aufzählung
18 Results Optimal deployment / positioning in 5 of 6 animals Stent position heterotop (n=1; 4 days) Normal hemodynamics, no arrhythmias (n=5) No migration, embolization and paravalvular leakage Gross evaluation: Tissue growth at 4 weeks / 8 weeks: 50% / 70% No thrombus formation Fracture of the atrial elements (septal side) in 2 animals Lutter G, Lozonschi L, Cremer J J Thorac Cardiovasc Surg Dept. of Cardiovascular Surgery
19 Hemodynamic Data Mitral valve gradient (max) Animal 1h after four-week / 8-week follow-up [mmhg] [mmhg] / * Average SD MVG: mean transvalvular gradient (mmhg); *not applicable Lutter G, Lozonschi L, Cremer J J Thorac Cardiovasc Surg. 2010
20 Hemodynamic Data LVOT gradient (max) Animal 1h after four-week / 8-week follow-up [mmhg] [mmhg] / * * Average SD LVOT: gradient across the left ventricular outflow tract (mmhg); *not applicable Lutter G, Lozonschi L, Cremer J J Thorac Cardiovasc Surg. 2010
21 Transesophageal echocardiography Lutter G, Lozonschi L, Cremer J J Thorac Cardiovasc Surg. 2010
22 Echocardiographic Data Mitral regurgitation Animal Before 1h after four-week / 8-week follow-up 1 none none none 2 none none none 3 none none none 4 none none none 5 none none - / none 6 none mild * Lutter G, Lozonschi L, Cremer J J Thorac Cardiovasc Surg. 2010
23 Überschrift Normaler Text Aufzählung
24 CT investigation 2 month after implantation
25 Mitral valved stent at 8 weeks after implantation Lutter G, Lozonschi L, Cremer J Dept. of Cardiovascular Surgery J Thorac Cardiovasc Surg. 2010
26
27
28
29 Conclusion Transapical mitral valved stent implantation: Off-pump Reproducible Reliable stent stability Minimal gradient LVOT Good valve function Survival time of up to 8 weeks Lutter G, Lozonschi L, Cremer J J Thorac Cardiovasc Surg. 2010
30 Special Thanks to UNIVERSITÄTSKLINIKUM Pokorny S Bähr T Pohanke J Dai H Metzner A David Steimer Gunther Fischer Jessica Boldt Marczynski-Bühlow Huenges K Boldt J Gegenwart M Elena Hensler Thorsten Lankau Dr. Kenji Iino Dirk Theisen-Kunde Jochen Cremer Lucian Lozonschi Vidlund B Christian Faller René Bombien Maria Heusterberg Shamita Chattopadhyay Prof. Schultheiss supported by
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