Hở van hai lá do thiếu máu cơ tim có gì mới năm 2014

MR decreases survival after diagnosis Grigioni F et al.. Ischemic MR The old Paradigm: Chronic Ischemic MR is due to annular dilatation , and should be corrected by annuloplasty... Co

Ischemic Mitral Regurgitation:

What we can do in 2014

Peter M Pollak MD

Disclosure Relevant Financial Relationship(s)

Off Label Usage

MR decreases survival after diagnosis

Grigioni F et al Circulation 2001;103:1759-1764 Copyright © American Heart Association, Inc All rights reserved

Ischemic MR

The old Paradigm:

Chronic Ischemic MR is due to

annular dilatation , and should be corrected by

annuloplasty

Comparison Ischemic MR-Atrial Fibrillation

Otsuji JACC 2002

Ischemic MR

The New Paradigm:

There is more to Ischemic MR than just

annular dilatation

Forces on mitral leaflets in systole

Levine R A , and Schwammenthal E Circulation 2005;112:745-758

Patch placement and balloon inflation over

infarct region improves MR

Levine R A , and Schwammenthal E Circulation 2005;112:745-758

Medical Therapy is Important

Tischler AJC 1998

Effect of Enalapril 10mg

on LVSV in Patients with severe MR

Varadarjan AJC 2008

Beta Blocker effect on

survival in patients with

severe MR

Medical Therapy Effect from Heart

Failure Reference Trials

McDonagh ESC 2014

CRT improves Ischemic MR

Van Bomel CIRC 2011

• Temporary effect during CRT

• MR returns when CRT off

Response to CRT correlates with survival

Van Bomel CIRC 2011

MitraClip Device

MitraClip is successful in treating MR

MitraClip survival similar to surgery

Ischemic MR : Survival after Surgery

P = 0.05

44  4

25  4 1980’s

Surgical Repair vs Replacement

ERO >0.4cm2

12 month follow-up

©2011 MFMER | 3138928-20

Acker MA et al N Engl J Med 2014;370:23-32

Summary

patients

helpful for severe MR

Thank you!

Pollak.peter@mayo.edu