3η Διημερίδα Καρδιο Ογκολογίας · 10 years: 10% the single most frequent...
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3 η Διημερίδα Καρδιο - Ογκολογίας / Καρδιακής Ανεπάρκειας Νέες διαδερμικές ή ελάχιστα επεμβατικές τεχνικές Dr. George Karavolias, MD, PhD, FESC, FACC Interventional Cardiologist Metropolitan Hospital Athens, Greece
Transcript of 3η Διημερίδα Καρδιο Ογκολογίας · 10 years: 10% the single most frequent...
3η Διημερίδα Καρδιο - Ογκολογίας / Καρδιακής Ανεπάρκειας
Νέες διαδερμικές ή ελάχιστα επεμβατικές τεχνικές
Dr. George Karavolias, MD, PhD, FESC, FACC
Interventional Cardiologist
Metropolitan Hospital
Athens, Greece
Epidemiology of Heart Failure
➢HF incidence ~1% in age≥65
➢Survival has improved in most subgroups
➢ 5 years: 50%
➢ 10 years: 10%
➢ the single most frequent cause of hospitalization in persons aged ≥65 years
➢>1M Hospitalizations and 3.4M office visits
➢Estimated annual costs in US: $40B
Benjamin EJ et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the AHA. Circulation 2017; 135:e146-e603
Primary Targets of Treatment in Heart Failure
NEJM 2003 TCT 2017
N Engl J Med 2003;348:2007-18.
➢ Electrical Therapy
➢ Hemodynamic Support
➢ Percutaneously Delivered Biological Therapies
➢ Left Ventricular Remodelling Devices
➢ Left-to-Right Interatrial Shunt Devices
➢ Neuromodulators
➢ Renal Denervation
➢ Implantable Hemodynamic Monitoring
➢ Percutaneous Interventions in Functional Mitral Regurgitation
➢ Percutaneous Tricuspid Valve Repair
Transcatheter Structural Heart Interventions forthe Treatment of CHF
Electrical Therapy of Heart Failure
ICD CRT
Hemodynamic Support
IABP
Impella
ECMO
Cardiac Interventions Today 2018 Vol. 12, No. 1
Percutaneously Delivered Biological Therapies
Cell therapy for CHF Gene therapy for CHF
Pleger S et al. Circ Res. 2013;113:792-809Sanganalmath S et al. Circ Res. 2013;113:810-834
Transcatheter Structural Heart Interventions forthe Treatment of CHF
➢ Electrical Therapy
➢ Hemodynamic Support
➢ Percutaneously Delivered Biological Therapies
➢ Left Ventricular Remodelling Devices
➢ Left-to-Right Interatrial Shunt Devices
➢ Neuromodulators
➢ Renal Denervation
➢ Implantable Hemodynamic Monitoring
➢ Percutaneous Interventions in Functional Mitral Regurgitation
➢ Percutaneous Tricuspid Valve Repair
Transcatheter Structural Heart Interventions forthe Treatment of CHF
Left Ventricular remodelling devices
Parachute Revivent TC
Parachute Ventricular Partitioning Device
CE mark: 10/2012
Parachute Ventricular Partitioning Device
LVEDVI & LVESVI 6MWD
Marco A. Costa et al. Circ Heart Fail. 2014;7:752-758
34 patients:↓ LV volume↑ NHYA
Parachute Ventricular Partitioning Device
Clinical outcomes
Marco A. Costa et al. Circ Heart Fail. 2014;7:752-758
Revivent TC
Wechsler AS, et al.. Eur J Cardiothorac Surg. 2013;44:e189–92
Hernández-Enríquez et al., Abstract presented at EuroPCR 2016
CE mark: 12/2016
Revivent TC
LVEDVI LVESVI
Wechsler AS, et al Eur J Cardiothorac Surg. 2013;44:e189–92
71 patients:↓ LV volume↑ LVEF ↑ 6MWD
➢ Electrical Therapy
➢ Hemodynamic Support
➢ Percutaneously Delivered Biological Therapies
➢ Left Ventricular Remodelling Devices
➢ Left-to-Right Interatrial Shunt Devices
➢ Neuromodulators
➢ Renal Denervation
➢ Implantable Hemodynamic Monitoring
➢ Percutaneous Interventions in Functional Mitral Regurgitation
➢ Percutaneous Tricuspid Valve Repair
Transcatheter Structural Heart Interventions forthe Treatment of CHF
Left-to-Right Interatrial Shunt Devices
Atrial Flow Regulator TV-Wave deviceIASD system
https://citoday.com/2018/02/technologies-for-treating-left-atrial-decompression-in-heart-failure
Left-to-Right Interatrial Shunt Devices
https://citoday.com/2018/02/technologies-for-treating-left-atrial-decompression-in-heart-failure
Interatrial Septal Device System
https://corviamedical.com/treatment/
The V-Wave device
http://vwavemedical.com/
(unidirectional device)
Left-to-Right Interatrial Shunt Devices
➢ Electrical Therapy
➢ Hemodynamic Support
➢ Percutaneously Delivered Biological Therapies
➢ Left Ventricular Remodelling Devices
➢ Left-to-Right Interatrial Shunt Devices
➢ Neuromodulators
➢ Renal Denervation
➢ Implantable Hemodynamic Monitoring
➢ Percutaneous Interventions in Functional Mitral Regurgitation
➢ Percutaneous Tricuspid Valve Repair
Transcatheter Structural Heart Interventions forthe Treatment of CHF
Neuromodulators
PCR innovators day - 16 May 2016 – Paris
Neuromodulators
Neth Heart JDOI 10.1007/s12471-017-1018-
The Cardiofit device(vagal nerve stimulation)
Eur Heart J. 2014;36(7):425-433.doi:10.1093/eurheartj/ehu345
CE mark: 2009
▪ LVEDD
▪ LVESV
▪ LVEF
▪ BNP
➢↑ quality of life (P = 0.049)
➢↓ NYHA (P = 0.032)
➢↑ SF-36 Physical Component (P = 0.016)
The Cardiofit device
96 implanted patients:
NS vs. Control
European Heart Journal, 2015, 425–433https://doi.org/10.1093/eurheartj/ehu345
Barostim neo Electrical Stimulator(carotid baroreceptor reflex stimulator)
➢ Electrical Therapy of Heart Failure
➢ Hemodynamic Support
➢ Percutaneously Delivered Biological Therapies
➢ Left Ventricular Remodelling Devices
➢ Left-to-Right Interatrial Shunt Devices
➢ Neuromodulators
➢ Renal Denervation
➢ Implantable Hemodynamic Monitoring
➢ Percutaneous Interventions in Functional Mitral Regurgitation
➢ Percutaneous Tricuspid Valve Repair
Transcatheter Structural Heart Interventions forthe Treatment of CHF
Renal Denervation
Maria Del Trigo, and Josep Rodés-Cabau Circ Cardiovasc Interv. 2015;8:e001943
Renal Denervation
6MWT loop diuretic doses
➢ Electrical Therapy
➢ Hemodynamic Support
➢ Percutaneously Delivered Biological Therapies
➢ Left Ventricular Remodelling Devices
➢ Left-to-Right Interatrial Shunt Devices
➢ Neuromodulators
➢ Renal Denervation
➢ Implantable Hemodynamic Monitoring
▪ Pulmonary Artery Pressure Monitors
▪ Left Atrial Pressure Monitoring
➢ Percutaneous Interventions in Functional Mitral Regurgitation
➢ Percutaneous Tricuspid Valve Repair
Transcatheter Structural Heart Interventions forthe Treatment of CHF
Monitoring Technologies
PCR innovators day - 16 May 2016 – Paris
Pulmonary Artery Pressure Monitoring SystemCardioMEMS
Circ Cardiovasc Interv. 2015;8:e001943DOI: 10.1161/CIRCINTERVENTIONS.114.001943
data are transmitted by telephone line to a website
Pulmonary Artery Pressure Monitoring SystemCardioMEMS
Hospital admissions Freedom from Hospital admissions or mortality
Circ Cardiovasc Interv. 2015;8:e001943DOI: 10.1161/CIRCINTERVENTIONS.114.001943
FDA approved for patients in NYHA Class III who have been hospitalized for HF in the previous year
Left Atrial Pressure Monitoring SystemHeartPOD
Jay Ritzema et al. Circulation. 2010;121:1086-1095doi: 10.1161/CIRCULATIONAHA.108.800490
Left Atrial Pressure Monitoring SystemHeartPOD
Jay Ritzema et al. Circulation. 2010;121:1086-1095doi: 10.1161/CIRCULATIONAHA.108.800490
8 am 12 am
➢ Electrical Therapy
➢ Hemodynamic Support
➢ Percutaneously delivered biological therapies and interventions
➢ Left Ventricular Remodelling Devices
➢ Left-to-Right Interatrial Shunt Devices
➢ Neuromodulators
➢ Renal Denervation
➢ Implantable Hemodynamic Monitoring
➢ Percutaneous Interventions in Functional Mitral Regurgitation
▪ Percutaneous Edge-to-Edge Repair
▪ Percutaneous Annuloplasty
▪ Transcatheter Mitral Valve Replacement
➢ Percutaneous Tricuspid Valve Repair
Transcatheter structural heart interventions forthe treatment of CHF
➢Percutaneous Edge-to-Edge Repair ➢ MitraClip System
➢ Pascal System
➢Annuloplasty
➢The Carillon Mitral Contour System
➢The Cardioband System
➢The Mitralign device
➢The Accucinch annuloplasty system
➢Transcatheter Mitral Valve Replacement
Percutaneous Interventions in Functional Mitral Regurgitation
Percutaneous Edge-to-Edge Repair
MitraClip System Pascal System
MitraClip System for the Treatment of Functional Mitral Regurgitation: Ongoing Randomized Trials
Circ Cardiovasc Interv. 2015;8:e001943.DOI: 10.1161/CIRCINTERVENTIONS.114.001943
MitraClip
MitraClip
Baseline Post MitraClip
Annuloplasty
➢The Carillon Mitral Contour System
➢The Cardioband System
➢The Mitralign device
➢The Accucinch annuloplasty system Cardioband
NeoChord
MitraClip
Carillon
ARTO
Mitral Loop Cerclage
Mitralign
The Carillon Mitral Contour System
CE mark: 2011
36 pts, 12-month follow-up:↓ regurgitant jet area↓ left atrium area↓ regurgitant volumes↓ effective orifice area
Eur J Heart Fail. 2012;14:931–938. doi: 10.1093/eurjhf/hfs076.
The Mitralign device
61 pts, 12-month follow-up:↓ MR (≤2+ in 55% of patients)↓ NYHA↑ QoL
Dr Nicking, TVT 2014
The Cardioband System
29 pts, 6-month follow-up:↓ MR (≤2+ in 92% of patients)↓ NYHA (81%)
Francesco Maisano, PCR London Valves 2014
Matteo Pagnesi et al. JCIN 2018;11:517-528
Transcatheter MV Replacement
CardiAQ valve Tiara Valve
Fortis valveTendyne valve
valve systems with available first-in-man data
Transcatheter MV Replacement (Tiara Valve)
EuroIntervention. 2014;10(suppl U):U115–U119.doi: 10.4244/EIJV10SUA17.
➢ Electrical Therapy
➢ Hemodynamic Support
➢ Percutaneously Delivered Biological Therapies And Interventions
➢ Left Ventricular Remodelling Devices
➢ Left-to-Right Interatrial Shunt Devices
➢ Neuromodulators
➢ Renal Denervation
➢ Implantable Hemodynamic Monitoring
➢ Percutaneous Interventions in Functional Mitral Regurgitation
➢ Percutaneous Tricuspid Valve Repair
Transcatheter Structural Heart Interventions forthe Treatment of CHF
TriCinch System
JACC Cardiovasc Interv. 2015;13:e211–e4
TriCinch System
JACC Cardiovasc Interv. 2015;13:e211–e4
FORMA Repair System
J Am Coll Cardiol. 2015;66:2475–83
FORMA Repair System
J Am Coll Cardiol. 2015;66:2475–83
Conclusions
➢ new transcatheter structural heart interventions for chronic HF are currently being developed
➢ preliminary results associated with most of these new interventions are promising
➢ data from most of these technologies are restricted to first-in-man cases and observational studies,limited by experience and number of patients
➢ randomized studies that can provide definite data on the efficacy of these devices
