FOR THE MITRAL VALVE No disclosures Outline Epidemiology of MV - - PowerPoint PPT Presentation

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FOR THE MITRAL VALVE No disclosures Outline Epidemiology of MV - - PowerPoint PPT Presentation

Jan 31, 2024 13 likes •463 views

Georges Ephrem MD, MSc, FACP, FACC Adult Congenital Heart Disease & Structural Heart Interventional Fellow @drephrem PERCUTANEOUS OPTIONS FOR THE MITRAL VALVE No disclosures Outline Epidemiology of MV disease Established

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PERCUTANEOUS OPTIONS FOR THE MITRAL VALVE

Georges Ephrem MD, MSc, FACP, FACC

Adult Congenital Heart Disease & Structural Heart Interventional Fellow @drephrem

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No disclosures

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Outline

  • Epidemiology of MV disease
  • Established percutaneous interventions

– Native MV – Artificial MV

  • Prospects/future directions in interventions
  • Current and prospective milestones for

peri-procedural echocardiography

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Epidemiology of MV disease

Coffey S, et al. Heart 2016;102:75–85. doi:10.1136/heartjnl-2014-307020

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Native MV

ESTABLISHED PERCUTANEOUS INTERVENTIONS

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PBMV

  • Severe MS (MVA <1.5 cm2), favorable morphology and no

contraindications (e.g. LA thrombus or significant MR) (Class I)

  • Asymptomatic patients with MVA <1.5 cm2, pHTN (PASP>50

mm Hg at rest or >60 mm Hg with exercise), and favorable morphology (Class I)

  • Calcific MS + high risk for surgical commissurotomy IF NYHA

FC III-IV and severe MS (MVA <1.5 cm2) (Class IIa)

  • Consider if lower risk for surgical commissurotomy (Class IIb)
  • NYHA FC II-IV with MVA >1.5 cm2 and pHTN (Class IIb)
  • Asymptomatic with MVA<1.5 cm2 & new A fib (Class IIb)

Nishimura et al. J Am Coll Cardiol. 2017 Jul 11;70(2):252-289. doi: 10.1016/j.jacc.2017.03.011.

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PBMV

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PBMV

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MitraClip

Feldman T, et al. N Engl J Med. 2011 Apr 14;364(15):1395-406. doi: 10.1056/NEJMoa1009355.

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MitraClip

J Obadia et al. N Engl J Med 2018. DOI: 10.1056/NEJMoa1805374

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MitraClip

GW Stone et al. N Engl J Med 2018. DOI: 10.1056/NEJMoa1806640

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MitraClip

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MitraClip

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MitraClip

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Artificial MV

ESTABLISHED PERCUTANEOUS INTERVENTIONS

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Valve in Valve

Yoon SH et al. Eur Heart J. 2018 Oct 23. doi: 10.1093/eurheartj/ehy590. Guerrero M et al. Circulation. 2018;136:A23085

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Paravalvular leak closure

  • 141 defects,115 patients,

78% MV

– 93% CHF, 37% hemolytic anemia – Technical success rate 89% – 72% of survivors free of severe symptoms or need for surgery at 3-yr follow-up

Rihal CS et al. JACC Cardiovasc Interv. 2012 Feb;5(2):121-30.

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PROSPECTS/FUTURE DIRECTIONS IN INTERVENTIONS

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Valve in valve

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Valve in ring

Yoon SH et al. Eur Heart J. 2018 Oct 23. doi: 10.1093/eurheartj/ehy590. Guerrero M et al. Circulation. 2018;136:A23085

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Valve in ring

  • MITRAL-ViR arm

– 30 patients, all transseptal access

  • Technical success 70%

– Second valve in 6 patients with good outcomes

  • 2 in-hospital deaths

– Procedural success at 30 days 62% – 7 ASA to increase likelihood of procedural success

Guerrero M et al. Abstract presentation at TCT 2017

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Valve in ring

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Valve in MAC

Guerrero M et al. JACC Cardiovasc Interv. 2016 Jul 11;9(13):1361-71. doi: 10.1016/j.jcin.2016.04.022.

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Valve in MAC

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LAMPOON

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New devices

Ruiz CE et al. J Am Coll Cardiol. 2015 Jul 14;66(2):169-83. doi: 10.1016/j.jacc.2015.05.034.

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PASCAL

Praz F et al. Lancet. 2017 Aug 19;390(10096):773-780. doi: 10.1016/S0140-6736(17)31600-8.

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Tendyne

Duncan A et al. EuroIntervention. 2017 Oct 13;13(9):e1047-e1057. doi: 10.4244/EIJ-D-17-00154.

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TIARA

Cheung A et al. JACC Cardiovasc Interv. 2017 Oct 9;10(19):2012-2014. doi: 10.1016/j.jcin.2017.08.019.

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,Pascal

Ruiz CE et al. J Am Coll Cardiol. 2015 Jul 14;66(2):169-83. doi: 10.1016/j.jacc.2015.05.034.

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CURRENT AND PROSPECTIVE MILESTONES FOR PERI- PROCEDURAL ECHOCARDIOGRAPHY

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CURRENT

  • Mastery of

procedure-specific TEE requirements

  • Mastery of modified

angles and/or axes to accommodate for atypical anatomy

  • Comfort with 3D

TEE

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Illumination or pseudo-colorization

Going forward

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Ruiz CE et al. J Am Coll Cardiol. 2015 Jul 14;66(2):169-83. doi: 10.1016/j.jacc.2015.05.034.

F U S I O N I M A G I N G

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Ruiz CE et al. J Am Coll Cardiol. 2015 Jul 14;66(2):169-83. doi: 10.1016/j.jacc.2015.05.034.

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Thank you for your attention