Ischemic Heart Failure Trial Commentary : Alec Vahanian Bichat - - PowerPoint PPT Presentation

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Ischemic Heart Failure Trial Commentary : Alec Vahanian Bichat - - PowerPoint PPT Presentation

Mar 11, 2023 243 likes •366 views

Influence of Mitral Regurgitation on Survival in the Surgical Treatment for Ischemic Heart Failure Trial Commentary : Alec Vahanian Bichat Hospital, Paris, France Disclosure Information A) Relationship with companies who manufacture products

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Influence of Mitral Regurgitation on Survival in the Surgical Treatment for Ischemic Heart Failure Trial

Commentary : Alec Vahanian Bichat Hospital, Paris, France

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Disclosure Information

A) Relationship with companies who manufacture products used in the treatment of the subjects under discussion Relationship Manufacturer(s) Speaker's Honoraria Edwards Lifesciences Consultant (Advisory Board) Medtronic, Abbott, Valtech

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  • A large contemporary study, including well characterised

patients with Low LV ejection fraction, and a long Follow-up

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IMR in Candidates for CABG and Low EF

Findings :

  • Moderate and severe IMR are frequent (18%) in patients with

Low EF considered for CABG

  • Patients with “significant” IMR have worse presenting

characteristics (higher NYHA classIII/IV, lower LVEF, larger LVESI, higher estimated operative risk) Remarks : Limitations in the assessment of severity of MR ( absence of Corelab, integrative quantification ?) Merging moderate and severe MR is unusual

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All-Cause Mortality Estimates for 534 MED Patients by MR Severity

Remark:Is IMR « the chicken or the egg » in patients with IMR and LV dysfunction?

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Patients with Moderate /Severe MR undergoing CABG+/- MVR

  • 91Pts, 49 underwent MVR
  • Patients who underwent MVR had :

More pre op. PCI, worse LVEF, larger LVESVI, More complicated post operative outcome BUT

  • nly 2% operative mortality
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All-Cause Mortality Estimates for 195 Patients with Moderate/Severe MR

Adjusted CABG + MVP : CABG 0.45 0.23, 0.90

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Patients with Moderate /Severe MR undergoing CABG+/- MVR

Remarks :

  • Decision of MVR left to the operator
  • Possibility of heterogeneity in repair techniques
  • Limitations in design: No RCT, no Multivariate analysis
  • Lack of information on: residual MR, re-hospitalisations
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What is Needed to Improve the Evidence on Usefulness of MVR in Ischemic MR?

  • Dedicated RCT
  • Improvement of Pre operative evaluation

Comprehensive quantification of MR at rest and dynamic Identification of predictors of recurrence of MR Myocardial viability

  • Evaluation of Techniques

Annuloplasty, including dynamic components LV « remodelling » Percutaneous techniques…

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extra hours

Talent & Innovation Engagement

10.000