New ACC/AHA/HFSA Guidelines
Stages, Phenotypes and Treatment of HF
ValvularHeart Disease and Heart Failure
Etiology of Chronic Mitral Insufficiency
PrognosticImpactofFMR
1250 HF pts mean EF 32+-8% were screened (ICM+NICM)(27% had no MR,49% mild to moderate, 24% severe MR)
Outcomes for Annuloplasty for Secondary MR
Replacement and Repair in Secondary MRhave Similar Outcomes but Repair has Higher Recurrence
TranscatheterApproaches for Severe MR
MitraClip
Coronary sinusannular devices
Direct annuloplasty
Septal shortening devices
Percutaneous neochords
Trancatheter MV Replacement
- Trans-apical
- Trans-septal
MitraClip Percutaneous Mitral Valve Repair
MitraClip System: US Clinical Trial Experience
EVEREST High Risk Registry
Baseline Demographics and Co-Morbidities
Observed 30-day Mortality Lower than Predicted Surgical Mortality
Post-Procedure and Discharge Results
Mitral Regurgitation Grade
NYHA Functional Class
SF-36 Quality of Life Scores
Lower Mortality in MitraClip patients at 1 year compared to Concurrent Control (p = 0.047)
Hospitalizations for Heart Failure
Randomized Clinical Trials – MV repair for secondary MR
Everything Else
Coronary Sinus Approach
Cardiac Dimensions Carillon XE 2 Device
Direct Annuloplasty Approaches
Mitralign CE Mark Study (64 pts)
Valtech Cardioband
Transeptal access super-annular implant by TEE/Fluoro guidance
Millipede
Transcatheter mitral annular reduction with a self-centering, positioning, and attaching device
Role of Annular Devices
Carillion and Cardioband (bought by Edwards) about to start US trials
Mitralign abandoned mitral space to concentrate on Tricuspid
Restricted only to Secondary MR
Much is dependent on the results of COAPT
Could possibly be used in combination with MitraClip in patients withlarge annulus
Trans-catheter Mitral Valve Replacement TMVR
TMVR Challenges
Does Transcatheter Therapies Make a Difference of VHD on the management of HF
Mitral Valve Repair- MAYBE…
Post MI ischemic MR is clearly a risk for poor outcomes
Secondary MR, nonischemic, is a phenomenon of remodeling; remainsuncertain that treatment perse changes the natural history of HF
Appropriate to persist with major RCTs addressing MVrepair vs GDMT with CRT where indicated
The GDMT bar is higher than ever thus percutaneous MVrepair will need to be remarkably effective
Tricuspid regurgitation is frequent butrarely treated
1. Singh JP, et.al. Prevalence andClinical determinants of mitral, tricuspid, and aortic regurgitation, Am J Cardiol. 1999;83:897-902
2.McCarthy P.M, Sales V.L , Evolving Indications for TricuspidValve Surgery. Curr Treat Options Cardiovasc Med. 2010 Dec; 12(6): 587–597.
Tricuspid regurgitation is associated with increasedmortality
Tricuspidregurgitation is predominately a consequence of RV and annular dilation:functional TR
Transcatheteroptions for FTR
Mitraclip and the Drive-thru option（“surgical-like”approach）
MITRACLIP in tricuspid position
TR Reduction
Clinical improvement
TRI-REPAIR study: Efficacy
Millipede
Trialign
4TECH TriCinch: septo-anterior cinching
2° Gen TriCinch to improve tissue retention
The TRAIPTA concept
Eterotopic implantation: the CAVIconcept
Patient selection: timing
Conclusions
Large unmet clinicalneed
Today, patients whoare worldwide treated with transcatheter tricuspid valve therapy are mostly high-riskpatients with functional etiology and very severe central regurgitation, mostly with notseverely impaired RV function.
Initial resultssuggest that transcatheter tricuspid valvetherapy is feasible with different techniques. Clinical efficacy isstill to be determined.
Openissues: Indication, patientselection, Imaging, Assessment of outcomes
Need for standardized definitions →time for TVARC?
专家简介
马根山
东南大学附属中大医院
主任医师，教授，心血管科主任，博士研究生导师。现任东南大学附属中大医院心血管内科主任、东南大学心血管病研究所副所长。
长期从事心血管病临床医疗工作，对危重病人的抢救有丰富的经验。自1989年开始从事介入性心脏病工作，曾在澳大利亚专门研修心脏病介入治疗术1年。擅长冠心病介入治疗、心脏电生理检查和心脏起搏器置入术，尤其是冠心病的介入治疗技术在国内享有较高的声誉。已独立完成和指导完成冠状动脉球囊成型术和支架术2500余例，组织和主持国际性冠心病血运重建学术会议6次。在国内外核心期刊发表中英文论著40余篇、主编介入心脏病学专著2部，参编专著、教材8部。获得江苏省科技进步奖5项、市厅级科技奖8项。负责国家自然科学基金课题1项、国家“十五”科技公关协作课题1项、“973”子课题1项、省部级课题10项。指导毕业硕士、博士研究生10名。兼任美国心脏病学学会委员、中华医学会心血管分会冠脉介入心脏病学组委员、中国医师协会心血管内科医师分会常务委员、江苏省医学会心血管病分会常务委员、江苏省中西医结合心血管学会副主任委员、南京市中西医结合学会常务理事。为江苏省“333”工程培养人才和省“科教兴卫”医学重点人才。
