ECHO 2013 / Transcatheter Aortic and Mitral Valve Replacement The Future is Now 2
.pdf
Mitral Regurgitation (MR)
occurs as a result
Leaflet Malcoaptation
Primary Disorder of the Valve |
|
Functional MR |
|
• Degenerative MR |
|
• |
Leaflets are normal |
- Flail, Prolapse |
|
• |
MR occurs due to LV |
• Rare disease |
|
|
enlargement, annular |
- endocarditis, rheumatic |
|
|
dilatation etc |
|
|
|
|
|
|
|
|
Not all DMR is created equal
European Heart Journal (2010) 31, 1958–1967
Mitral Regurgitation Complexity
Degenerative MR
Goal: Restore Leaflet Coaptation
Carpentier A. “The French Correction.” J Thorac Cardiovasc Surg 1983;86:323.
Functional MR: multi-factorial
Left ventricular dysfunction
Leaflet Annular tethering dilatation
Functional/Ischemic MR Treatment
Annular or Ventricular
Shape Change
Relative Sizes of Clinical Needs
Degenerative vs Functional MR
Expected WW Ann. Incidence
Functional MR
e-Valve Degenerative MR |
~2,570,000 |
~650,000
Cardiac Dimensions
Guided Delivery Systems
Mitralign
Myocor
Viacor
Ample
Edwards
e-Valve
others
|
|
|
|
|
|
|
|
• |
Leaflet repair |
|
|
|
|
|
|
EValve Mitraclip |
|
|
|
|
|
|
|
|
|
|
|
|
|
Percutaneous |
|
• |
Coronary sinus annuloplasty |
||
|
|
|
Edwards Monarc |
||
|
|
|
|
||
Mitral |
|
|
|
Cardiac Dimensions Carillon |
|
Approaches |
Viacor Shape Changing Rods |
|
•Direct annuloplasty
Mitralign Suture-Based Plication
Guided Delivery Anchor-Cinch Plication
Quantum Cor
•Chamber + annular remodeling
Myocor iCoapsys
Ample PS3
•Mitral valve replacement
Percutaneous Mitral-Valve Repair
MitraClip® System (Abbot Vascular)
MitraClip Concepts
Coaptation of Leaflets
Reduces MR
Creates tissue bridge
Limits dilatation of annulus
Septal-lateral (A-P) dimension
Supports durability of repair
Restrains LV wall
Limits LV dilatation
Attributes of the procedure
•Based on established surgical principle
•Percutaneous venous rather than arterial procedure
Less vascular complications
Lower stroke risk
•Procedure is intuitive
Echo guided transseptal procedure
•Repositionable and removable