Gregory P. Fontana, M.D., FACC, FACS National Medical Director for Cardiovascular Research And Innovation Hospital Corporation of America Medical Director for Cardiovascular Research Sarah Cannon Research Institute Director and Chairman Cardiovascular Institute of Los Robles Hospital and Medical Center Functional Mitral Regurgitation Requires Both a Mitral and a Ventricular Solution
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Functional Mitral Regurgitation Requires Both a Mitral · PDF fileFunctional Mitral Regurgitation Requires Both a Mitral and a Ventricular Solution. Func tiona lMR is a VENTRICULAR
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Gregory P. Fontana, M.D., FACC, FACS
National Medical Director for Cardiovascular Research And Innovation
Hospital Corporation of America
Medical Director for Cardiovascular Research
Sarah Cannon Research Institute
Director and Chairman
Cardiovascular Institute of Los Robles Hospital and Medical Center
Functional Mitral Regurgitation Requires Botha Mitral and a Ventricular Solution
Func tio na l MR is a VENTRIC ULAR Dise a se !
In No nisc he m ic a nd isc he m ic c a rd io m yo p a th ie s, g e o m e tric p e rturb a tio ns in the
le ft ve ntric le (LV) re sult in d ysfunc tio n o f the Mitra l Va lve a nd se c o nd a ry
(func tio na l) m itra l re g urg ita tio n (FMR).
An inc re a se in the in te rp a p illa ry d ista nc e , a nnula r d ila tio n, a nd e nha nc e d le a fle t
te the ring c o ntrib ute to se c o nd a ry MR.
THE VALVE ARC HITEC TURE IS NO RMAL
Surgery for FMR
Mitral Valve Replacement or Repair (annuloplasty)
56 years of experience
Whic h Ring is b e tte r (Be st)? ? Do e s size m a tte r, d o e s Sha p e ?
Surg ic a l The ra p y a nd Func tio na l Im p ro ve m e nt
C o sg ro ve 2000
Im p ro ve d NYHA fro m 2.8 to 1.2
Re d uc e d Re a d m issio ns fo r He a rt Fa ilure
Pa tie nts to le ra te d hig he r d o se s o f Me d ic a l The ra p y
Ba d w a r a nd Bo lling 2002
4+ MR a nd Lo w EF (m e a n 14%)
NYHA 3.9 to 2.0
Ro m a no a nd Bo lling 2004
O ve r 200 p a tie nts
Im p ro ve d NYHA C la ss fro m 3.2 to 1.8
De Bo nis, Alfie ri 2005
Im p ro ve d NYHA 3.4 to 1.4
Ac ke r (Ac o rn Tria l) 2006
Be tte r Func tio na l C la ss, MLHF, Sho rt-fo rm 36, 6 m inu te w a lk
From: Randomized Comparison of Percutaneous Repair and Surgery for MitralRegurgitation: 5-Year Results of EVEREST II
J Am Coll Cardiol. 2015;66(25):2844-2854. doi:10.1016/j.jacc.2015.10.018
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Original Article
Two-Year Outcomes of Surgical Treatment of SevereIschemic Mitral Regurgitation(MV Repair vs Replacement)
Daniel Goldstein, M.D., Alan J. Moskowitz, M.D., Annetine C. Gelijns, Ph.D., GoravAilawadi, M.D., Michael K. Parides, Ph.D., Louis P. Perrault, M.D., Judy W. Hung, M.D.,
Pierre Voisine, M.D., Francois Dagenais, M.D., A. Marc Gillinov, M.D., VinodThourani, M.D., Michael Argenziano, M.D., James S. Gammie, M.D., Michael Mack, M.D.,Philippe Demers, M.D., Pavan Atluri, M.D., Eric A. Rose, M.D., Karen O’Sullivan, M.P.H.,
Deborah L. Williams, B.S.N., M.P.H., Emilia Bagiella, Ph.D., Robert E. Michler, M.D.,Richard D. Weisel, M.D., Marissa A. Miller, D.V.M., Nancy L. Geller, Ph.D., Wendy C.
Taddei-Peters, Ph.D., Peter K. Smith, M.D., Ellen Moquete, R.N., Jessica R.Overbey, M.S., Irving L. Kron, M.D., Patrick T. O’Gara, M.D., Michael A. Acker, M.D., for
the CTSN
N Engl J MedVolume 374(4):344-353
January 28, 2016
Tim e -to -Eve nt C urve s fo r De a th .
Goldstein D et al. N Engl J Med 2016;374:344-353
Time-to-Event Curves for Major Adverse Cardiac or Cerebrovascular Events (MACCE).
Goldstein D et al. N Engl J Med 2016;374:344-353
Quality-of-Life Scores.
Goldstein D et al. N Engl J Med 2016;374:344-353
C um ula tive Fa ilure o f Mitra l-Va lve Re p a ir o r Re p la c e m e nt.
Goldstein D et al. N Engl J Med 2016;374:344-353
No ve l De vic e Stra te g ie s… .o u tsid e the b o xMitra l Brid g e TM C o nc e p t
Tra n sva lvu la r Brid g e in SL d im e n sio n with
c e n te re d in fra a n n u la r c u rva tu re
Dire c t n o n p la n a r re d u c tio n in SL
d ia m e te r
Pre se rve s th e le a fle t c u rva tu re
sh o rte n s th e p a p illa ry m u sc le to le a fle t
d ista n c e
Le a fle t Re stra in t b e lo w th e a n n u la r
p la n e
C u rre n t d e vic e is a d a p ta b le fo r
tra n sc a th e te r d e live ry via 16 Fr C a th e te r
Anchoring Pad
Silicon-nitinol
Bridge
Ho w a b o ut p MVR p lus LV Re d uc tio n o r Sta b iliza tio n?
Proven Survival Benefit Benefit
Ho w a b o ut p MVR a nd LV Assist?
Tho se Unfa m ilia r with Histo ry a re d o o m e d to Re p e a t it?
In FMR
Pathophysiology: Ventricular Disease
Surgical Mitral Valve Repair or Replacement improveQuality of life NOT Quantity of Life!!
Replacement better than repair!
(Except Coapsys Device)
Improved survival will require a ventricular solution!