transcathetermitral valve implantation a self‐centering ... · corradotamburino, md, phd...
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Ferrarotto Hospital A.O.U. Policlinico-Vittorio EmanueleUniversity of Catania, Italy
Transcatheter Mitral Valve ImplantationA self‐centering & self‐axing device
Corrado Tamburino, MD, PhDFerrarotto Hospital, Catania University
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Ferrarotto Hospital A.O.U. Policlinico-Vittorio EmanueleUniversity of Catania, Italy
Potential conflicts of interest
Speaker's name: Corrado Tamburino
Speakers Honoraria: Abbott, Medtronic, Biosensors, Stentys
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Ferrarotto Hospital A.O.U. Policlinico-Vittorio EmanueleUniversity of Catania, Italy
HighLifeDevice Characteristics and Unique Features
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• The valve• 31mm TA valve• Bovine pericardium• Nitinol frame• Polyester cover
• The ring TF implant• Polymer tube• Nitinol hook• Polyester cover
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Ferrarotto Hospital A.O.U. Policlinico-Vittorio EmanueleUniversity of Catania, Italy
3‐step approach
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Step 1 : Guide wire looped around mitral leafletsStep 2 : Ring implanted over guide wire loopStep 3 : Valve‐in‐ring implantation
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Ferrarotto Hospital A.O.U. Policlinico-Vittorio EmanueleUniversity of Catania, Italy
Referral criteria and anatomical limitations
• Anatomy sizes that can currently be treated• Annulus range : 32‐45mm
• Virtual implantation on CT data to assess• LVOTO risk• LAA patency• Contact areas with LV wall
• Exclusions• Calcified native leaflets
• Potential risks• LVOTO• Entanglement in chords• contact with pap. muscles• LAA coverage
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Ferrarotto Hospital A.O.U. Policlinico-Vittorio EmanueleUniversity of Catania, Italy
Compassionate use patient• 68 year old Male (173 cm, 107 kg, BMI 36)• Functional severe mitral valve regurgitation• NYHA III• Risk scores
• ES 1: 32.8% ‐ ES 2: 8.6% ‐ STS: 2.9%
• Past medical history• CABG in 2015 (LAD, LCx, RCA)• Severe left ventricular dysfunction (EF 30%)• Moderate to severe pulmonary hypertension • Atrial septum not favorable for transeptal puncture
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Ferrarotto Hospital A.O.U. Policlinico-Vittorio EmanueleUniversity of Catania, Italy
Baseline mitral regurgitation
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Ferrarotto Hospital A.O.U. Policlinico-Vittorio EmanueleUniversity of Catania, Italy
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Ferrarotto Hospital A.O.U. Policlinico-Vittorio EmanueleUniversity of Catania, Italy
Ring insertion and closure
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Ferrarotto Hospital A.O.U. Policlinico-Vittorio EmanueleUniversity of Catania, Italy
Trans‐apical valve delivery
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Ferrarotto Hospital A.O.U. Policlinico-Vittorio EmanueleUniversity of Catania, Italy
Guidewire retrieval and final LV gram
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Ferrarotto Hospital A.O.U. Policlinico-Vittorio EmanueleUniversity of Catania, Italy
Assessment of valve function
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Ferrarotto Hospital A.O.U. Policlinico-Vittorio EmanueleUniversity of Catania, Italy
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Ferrarotto Hospital A.O.U. Policlinico-Vittorio EmanueleUniversity of Catania, Italy
Stable valve function at 30 days
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Ferrarotto Hospital A.O.U. Policlinico-Vittorio EmanueleUniversity of Catania, Italy
Clinical outcome N=8
• Procedure success 6 out of 8• 1 entanglement of ring in LV false chord
• 1 chordal entanglement upon trans‐apical delivery
• Clinical outcomes• 2 deaths from MOF at POD 4• Improvement of NYHA class by one grade in all patients after 3 months
• No major adverse events at follow‐up
• No valve related complication @6M FU
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0 100 200 300 400
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Patie
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Acute success, LV dysfunction + MOF
Re-intervention, MOF
Re-intervention
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Ferrarotto Hospital A.O.U. Policlinico-Vittorio EmanueleUniversity of Catania, Italy
Lessons learned
• Procedure reveals feasible and safe• Reversibility of loop placement is confirmed• Ring insertion and closure is efficient• Valve delivery over trans‐apical site is efficient• No PVL, no gradient• Up to 45mm annulus can be treated currently
• Multi‐modality imaging very important• Pre and intra procedural planning with CT is critical• Echocardiography is instrumental for loop position
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Ferrarotto Hospital A.O.U. Policlinico-Vittorio EmanueleUniversity of Catania, Italy
Conclusion
• Clinical proof of concept achieved with trans‐apical access
• Steep learning curve • Better patient selection• Improved procedure planning based on CT• Procedure time reduction
• True self‐axing and self‐centering within the ring implant
• Well suited for trans‐septal access and trans‐apical access
• Valve delivery perceived as easy by multiple users
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