Bệnh tim cấu trúc và bệnh lý van tim có gì mới trong năm 2015-2016

Mitral valve interventions Aortic valve interventions Lef atrial appendage occlusion Heart Failure interventions Patent Foramen Ovale closure... EVEREST II trial results.Maria Del Trigo,

Structural and Valvular interventions 2015-2016

A/Prof Michael Nguyen Fiona Stanley Hospital

Australia

Mitral valve interventions

Aortic valve interventions

Lef atrial appendage occlusion

Heart Failure interventions

Patent Foramen Ovale closure

Mitral Valve Interventions

How the d evice works

EVEREST 2

1 78 80 136 75

1 28 69

1 17 63

109 54

98 49

45 21

1 78 80 165 76

15 8

70

1 43 65

133 57

58 24 Dev i ce G r o

C on t rol G r o up

c Freedom From MV Surgery or Reoperation D Landmark Analysis of Freedom From MV Surgery or

Reoperatton Beyond 6 Months

98 49

11 7 63

109 54

98 49

45 2

EVEREST II trial results.

Maria Del Trigo, and Josep Rodés-Cabau Circ Cardiovasc

Interv 2015;8:e001943

Table 3 EVEREST II Trial: 5-Year Follow-Up Data Accordingto MR Etiology

Freedom from mortality

Freedom from MV surgery or reoperation

55% [27%-76%]

81 % [33%-96%] 86% 100% -13.2 -5.2 lVEDV indicates left ventricular end-diastolic volume; lVESV, left ventricular end-systolic volume; MR, mitral regurgitation; MV, mitral valve; and NYHA, New York

Heart Association functional class.

Percutaneous mitral annuloplasty devices.

Maria Del Trigo, and Josep Rodés-Cabau Circ Cardiovasc

Interv 2015;8:e001943

TITAN 2 : Carillon Mitral Device

Percutaneous Mitral Valve

Replacement

CardiAQ valve.

Ole De Backer et al Circ Cardiovasc Interv 2014;7:400-409

Tiara valve.

Ole De Backer et al Circ Cardiovasc Interv 2014;7:400-409

Tendyne valve.

Ole De Backer et al Circ Cardiovasc Interv 2014;7:400-409

Medtronic transcatheter mitral valve.

Ole De Backer et al Circ Cardiovasc Interv 2014;7:400-409

Valtech’s Cardiovalve is a transcatheter mitral valve replacement system designed to be

implanted using the transfemoral route.

Ole De Backer et al Circ Cardiovasc Interv 2014;7:400-409

HighLife transcatheter mitral valve replacement system.

Ole De Backer et al Circ Cardiovasc Interv 2014;7:400-409

MitrAssist’s valve-in-valve: a valve that assists the existing valve.

Ole De Backer et al Circ Cardiovasc Interv 2014;7:400-409

TAVR

AccurateTM

TAVR outcomes

US outcomes

80 30

70 21.0 60

40

20 10

80 3

70 20 60

50 1 40

Lef Atrial Appendage Occlusion

Primary Efficacy Endpoint

Hazard Ratio with Watchman, 0.66 (95% CI, 0.45 – 0.98)

1 2

Structural interventions for HF

The left atrial pressure monitoring system.

Maria Del Trigo, and Josep Rodés-Cabau Circ Cardiovasc

Interv 2015;8:e001943

The pulmonary artery pressure monitoring system.

Maria Del Trigo, and Josep Rodés-Cabau Circ Cardiovasc

Interv 2015;8:e001943

Left-to-right interatrial shunt devices.

Maria Del Trigo, and Josep Rodés-Cabau Circ Cardiovasc

Interv 2015;8:e001943

The parachute device.

Maria Del Trigo, and Josep Rodés-Cabau Circ Cardiovasc

Interv 2015;8:e001943

S tat us

53 °/o

Im pr ov ed

36 % M a i n ta i n d

PFO Occlusion

RESPECT - Extend

AMPLATZER 499 (0%) 463 (1.2%) 369 (1.5%) 22 (2 5%) 86 (2.5%)

MM 481 (0%) 394 (2.7%) 307 (4.1%) 168 (4 1%) 71 (5.2%)

54 % Relative Risk Reduction in ITT Population

Medic l Ma n age m ent

( N =4 8 , # cryp t ogen i c st r okes = 1 )

D AM PLATZER ™ P F O O cc ( N =4 6 4 # cryp t ogenic st r

A M PLATZER 3 9 (0 %) 299 (0 6 %) 229 ( 1 0 %) 1 34 ( 1 5 %) 52 ( 1 5%)

M M 30 1 (0 %) 243 ( 3.6%) 186 ( 4 8 %) 105 (4 8 %) 45 (6.6 %)

Greater

75 % Relative

Risk Reduction in Recurrent Cryptogenic Stroke in ITT Population

.

Structural Interventions are rapidly increasing as a

fundamental treatment option for multiple areas of

cardiovascular disease

•

but should make sure that comprehensive research to

assess safety and long-term effcacy of these

procedures is undertaken

•

Dedicated training programs should be developed so that the best expertise can be achieved for our patients

The Future is Exciting!