How Tryton Will Change Daily Practice Joel Schneider, MD FACC UNCRex Healthcare Raleigh, NC Tryton Medical TCT Symposium October 31, 2016 “create order out of chaos”
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How Tryton Will Change Daily Practice
Joel Schneider, MD FACCUNC-Rex Healthcare
Raleigh, NC
Tryton Medical TCT SymposiumOctober 31, 2016
“create order out of chaos”
Disclosure Statement of Financial Interest
I, Joel Schneider, MD do not have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.
“Cognizant of economics and his resource use”
“Constantly trying to learn and improve his skills”
“Essential that he is efficient, effective, and focused on patient care”
Age: 55years oldFamily: 2 grown childrenExperience: 20+ years
“It’s a calling when you do this for a living…”
What does Carl want from Tryton
• New approach to bifurcation PCI
• Predictability and Improved Outcomes
• Cost Neutral or Defensible
Dilemma of Bifurcation Disease
vs
CONFIDENTIAL – NOT FOR DISTRIBUTION
• Methodology not established
• Technically complex
• Unpredictable results
• Increased procedural time
• Higher costs
• Increased risk for stent thrombosis
• Recurrent ischemia from side branch residual disease
• Higher restenosis rate
• Duration of DAPT unclear
• Repeat intervention options limited
• Procedural Concerns • Post Procedural Concerns
Clinical Dilemma of Bifurcation Disease
Tryton takes the side branch out of play
…Avoids the unpredictable nature of BIF and its consequences
Eliminate Two Stent Strategies for Bifurcation
T Stenting V Stenting Y Stenting Culotte * Crush*
Kissing Stent* *”gap” coverage
RCT and Confirmatory Study Combined
Tryton (n= 279)
Tryton: Side Branch Status
“All Comers” Studies % Patients % Lesions
Leaders Trial1,2 29.1% 21.6%
Nobori 23 17.5% 16.9%
xSearch4 22.2% N/A
Average 22.9% 19.3%
1. Windecker et al. Lancet 2008;; 372: 1163–732. Wykrzykowska, EuroPCR ’093. Danzi, EuroPCR ‘094. Serruys, ACC ‘08
How often will bifurcations come up in clinical practice?
Bifurcation Total PCI Volume
Total 360 3,492 10.3%
UNC-Rex 283 2,716 10.4%
Medical Center
77 776 9.9%
National 108,672 979,245 11.1%
BIFURCATION PCI NCDR DATACY 2015
US Potential Usage Estimated @ 15%: 146,886 Implants
BIFURCATION LESIONS at UNC-Rex and Medical Center
1.41
2
1.36
2
1.41
2
0
0.5
1
1.5
2
2.5
REX UNC
Average Number of Stents per Bifurcation Lesion
Average Stents per Lesion
2014 2015 2016
Bifurcation Cost Considerations
Values Bifucated Lesion Other PCI Grand Total
Count of Account Number/HAR 210 1,563 1,773
Average of Total Payments and Settlements 18,354 16,399 16,631
Average of Implant Cost (1DV) 2,633 2,435 2,459
Average of Drug Cost (3DV) 610 531 541
Average of Total Variable Cost (incl. Implant and drug) 10,273 9,286 9,403
Average of Contribution Margin 8,082 7,113 7,228
Average of Operating Income (Loss) w Settlements 1,578 1,511 1,519
Average of IP Days (Length of stay) 1.9 1.9 1.9
2013 Tryton OUS Experience:
>12.000 Patients Treated in > 30 Countries>1.800 Patients Studied by > 80 Physicians
The Tryton in the Hat?
“create order out of chaos”
Tryton Experience: Learning Curve
Faster procedures, Reduced Fluoroscopy, and Less Contrast as Experience Grows
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