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Semelhante a History and Future of Transcatheter Mitral Valve Interventions
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History and Future of Transcatheter Mitral Valve Interventions
- 3. Euro Heart Survey surgery is often denied in the older patients Isolated MR (n=877) Severe MR (n=546) No Severe MR (n=331) No Symptoms (n=144) Symptoms (n=396) No Intervention (n=193) 49% Intervention (n=203) 51% Mirabel et al, European Heart J 2007;28:1358-1365 2/3 of symptomatic MR patients >70 are denied surgery
- 4. Prevalence of valve disease in the population: MR is epidemic in the elderly Nkomo et al , Lancet 2006
- 6. AJC 3:653,1959 1959
- 7. JAMA 1966
- 8. 1984
- 9. 1998-2001, Edwards suction and suture device (MILANO 1)
- 10. 2002-2006 Edwards suction and suture device (MOBIUS / MILANO 2)
- 11. Clip repair in porcine heart (6 mos post repair) Fann JI; St. Goar FG; Komtebedde J; Oz MC; Block PC; Foster E; Feldman T; Burdon TA Circulation 2003, 108:(Supp IV) 493. 2002-2003 Off-pump Edge-to-Edge Mitral Valve Technique Using a Mechanical Clip in a Chronic Model – Initial clinical experience FIM (2003)
- 12. Worldwide experience about 750 patients treated
- 17. Percutaneous Mitral Valve Repair Prosthetic Ring Coronary Sinus Annuloplasty Safety at 30 Days Monarch Carillon Viacor n 69 43 26 Success implantation % 80 70 42 Death % 3 2 0 MI % 3 4 0 Tamponade % 3 4 4 Dissection CS % 0 2 8
- 18. Percutaneous Mitral Valve Repair Prosthetic Ring Coronary Sinus Annuloplasty Efficacy Monarc Carillon Viacor Pre 6 Mos Pre Post (TEE no core lab) n 21 Reduction MR>/=1+ 57% 63% NA ERO Cm² 0.31 0.20 0.33 0.19 NA Rvol ml 42 27 40 24 NA
- 27. Evalve MitraClip ® Device
- 28. Mitraclip
- 29. Description of Valve Repair System Guide Steerable sleeve Clip delivery handle Stabilizer Atrial Septum
- 33. EVEREST Preliminary Cohort Patients with 30 Day Major Adverse Events ( N = 107 )
- 34. EVEREST Preliminary Cohort Efficacy Results through Discharge N = 107 * Acute Procedural Success (APS): Defined as placement of one or more Clips resulting in discharge MR severity of 2+ or less , as determined by Core Lab. 70% of procedures are 1 st , 2 nd or 3 rd at Site
- 44. HRR FMR: Mitral Regurgitation (ITT) MitraClip therapy results in sustained MR reduction Mild-Moderate MR (Grade 1+/2+) Moderate-Severe or Severe MR (Grade 3+/4+) 52% of patients had MR grade 0 or 1+ at 12 months n=34, Matched Data 97% 3% 26% 18% 82% 74%
- 45. HRR FMR: LV Function (ITT) MitraClip therapy results in reverse LV remodeling n=34, Matched Data P=0.001 P=0.0002 LVEDV Baseline LVEDV 12 Months LVESV Baseline LVESV 12 Months 192 153 103 87 Systolic Diastolic
- 48. The future of endovascular mitral repair Early treatment Anatomical reconstruction Neochordae Implantation
- 49. Edwards Mobius di 22
- 50. TC orientation and capture
- 51. Chordal implant dynamic adjustment and post-mortem
- 55. Treating valve disease in the future today Tailored approach – the best option for the patient
Notas do Editor
- Ross J Jr, Braunwald E, Morrow AG AJC 3:653-655,1959 In 1958, while working at National Institutes of Health, Eugene Braunwald was director of a cath lab, and 1st Yr Fellow was John Ross. Ross was using sizing balloons to measure atrial septal defects in the cath lab. A visiting physician from Argentina observed this procedure and asked whether Ross had considered using a needle to puncture the intact septum. Ross discussed at doiner with EB, then requested time off from the cath lab, and developed a needle device in the dog lab. This was introduced into patients via femoral cutdown. A couple of years later when the Seldinger technique was introduced, a surgical resident working with Breaunwald designed a catheter, the Brockenbrough, through which the Ross needle could be placed. Related by EB March 09, 2004
- JAMA 196:991-992, 1966
- Here is a schematic movie the progressive shortening of the annulus and the theoretical changes of the geometry of the heart
- The third step is the implantation, the distal anchor is first deployed , than the proximal At the end of the procedure a coronary angiography is again performed to insure that there is no immediate coronary artery complication
- Removed “Remained Improved by 12 months” and put “improved by 12-months”. Remained improved implies the patients who improved at 30-days that were still improved at 12-months. 85% of the 82% 30-day successes were improved at 12-months. – this is 70% of the 30-day success patients. 79% of the total pop improved at 12months
- Paired T-Test