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Mitral Valve-To Clip or Not to Clip PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Mitral Valve: To Clip or Not to Clip" by Punit Goel, MD.

This medical PowerPoint presentation talks about Mitral valve.

Mitral valve regurgitation occurs when the mitral valve in the heart does not close properly, allowing blood to flow backward into the left atrium. This can cause symptoms such as fatigue, shortness of breath, and chest discomfort.

One treatment option for mitral valve regurgitation is the use of a mitral valve clip. This is a minimally invasive procedure where a small clip is placed on the mitral valve to help it close properly. The clip can improve symptoms, quality of life, and reduce hospitalization rates.

However, not all patients with mitral valve regurgitation are good candidates for a mitral valve clip. The decision to clip or not to clip depends on several factors, including the severity of the regurgitation, the patients overall health, and the presence of any other underlying medical conditions.

In some cases, the risks of the procedure may outweigh the potential benefits, and alternative treatments, such as medication or surgery, may be recommended. It is essential to discuss all treatment options with your doctor and make an informed decision based on your individual circumstances.

Tags : Mitral Valve, Mitral valve regurgitation, mitral valve clip, cardiology, cardiology PowerPoint presentation

Published on : Mar 17, 2023 | Views : 1696 | Downloads : 1

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Slide 1-

“Mitral Valve: To Clip or Not to Clip” Muhammad Raza, MD, FACC, FSCAI, RPVI. Interventional cardiologist Director, Cardiac Cath Lab, Crozer Chester Medical Center, Upland, PA
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Disclosure Consultant and Proctor – Medtronic Consultant – Abbott Vascular
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Structural Heart Disease Increases with Age Nkomo et al. Burden of Valvular Heart Diseases: A Population-based Study, Lancet, 2006; 368: 1005-11. > 9.3% for ≥75 year olds (p<.0001) 14 12 10 8 6 4 2 0 Prevalence (%) of moderate to severe valve disease Aortic valve disease Age (years) <45 45-54 55-64 65-74 >75 Mitral valve disease All valve disease
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Classification of MR – 2 Types Incompetent mitral valve closure Systolic retrograde blood flow from the LV into the LA Mayo Clinic (www.mayoclinic.com) Primary:Anatomic abnormality the mitral valve Leaflets Subvalvular apparatus Chordae and papillary muscles Secondary :LV dilation; often secondary to ischemic heart disease Leads to mitral annular dilation Incomplete coaptation of the mitral valve Mitral Regurgitation Etiologies
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Pathophysiology of MR Increasing Mitral Regurgitation Increase Load/Stress Muscle Damage/Loss Dysfunction of Left Ventricle Dilation of Left Ventricle 1 year mortality up to 57%1 1 Cioffi G, et al. Functional mitral regurgitation predicts 1-year mortality in elderly patients with systolic chronic heart failure. European Journal of Heart Failure 2005 Dec;7(7):1112-7
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What about therapy? MITRAL REGURGITATION Untreated severe MR is associated with increased morbidity and mortality
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Asymptomatic DMR Natural History Avierinos JF, et al. Circulation 2002;106:1355 100 90 80 70 60 50 Survival % 0 2 4 6 8 10 2 RF 1 RF 95 ±2 70 ±5 55 ±9 Risk Factors Age 50 yrsAtrial fibrillation LA enlargement Flail Mild MR MR 3orEF <50% Years after diagnosis
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Double Orifice RepairPublished Surgical Results Introduced by Alfieri for degenerative and functional MR >1000 repairs reported >10 y f/u Equivalent to standard surgical repair for short and long term outcomes No creation of stenosis of the orifice Overall freedom from re-operation 90% @ 5yrs
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MitraClip® Experience EVEREST I Feasibility (n=55) EVEREST II Pivotal Pre-Randomization (n=60) HR Registry (n= 78) Randomized (2:1 Clip to Surgery) (n= 279) Worldwide Commercial Use: >15,000 patients REALISM Registry Continued Access (n=965) Transcatheter Mitral Repair
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Transcatheter Mitral Repair May be considered for prohibitive risk patients with primary MR and severe symptoms despite GDMT (class IIb) ACC/AHA Guidelines – Primary MR
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The COAPT Trial Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation A parallel-controlled, open-label, multicenter trial in ~610 patients with heart failure and moderate-to-severe (3+) or severe (4+) secondary MR who remained symptomatic despite maximally-tolerated GDMT Randomize 1:1* MitraClip + GDMT N=305 GDMT alone N=305 *Stratified by cardiomyopathy etiology (ischemic vs. non-ischemic) and site See Important Safety Information Within. ©2019 Abbott. All rights reserved. AP2947499-US Rev A
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Primary Effectiveness Endpoint All Hospitalizations for HF within 24 months 0 3 50 100 150 200 250 300 0 MitraClip + GDMT GDMT alone 160 in 92 pts 283 in 151 pts Cumulative HF Hospitalizations (n) HR (95% CI] = 0.53 [0.40-0.70] P<0.001 6 9 12 15 18 21 24 Time After Randomization (Months) No. at Risk: Median [25%, 75%] FU = 19.1 [11.9, 24.0] mos See Important Safety Information Within. ©2019 Abbott. All rights reserved. AP2947499-US Rev A
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All-cause Mortality All-cause Mortality (%) 0% 20% 40% 60% 80% 100% 0 3 6 9 12 15 18 Time After Randomization (Months) 21 24 46.1% 29.1% HR [95% CI] = 0.62 [0.46-0.82] P<0.001 MitraClip + GDMT GDMT alone NNT (24 mo) = 5.9 [95% CI 3.9, 11.7] See Important Safety Information Within. ©2019 Abbott. All rights reserved. AP2947499-US Rev A
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MitraClip + GDMT GDMT alone All-cause Mortality or HF Hospitalization (%) 0% 20% 40% 60% 80% 100% 0 3 6 9 12 15 Time After Randomization (Months) 18 21 24 67.9% 45.7% No. at Risk: HR [95% CI] = 0.57 [0.45-0.71] P<0.001 NNT (24 mo) = 4.5 [95% CI 3.3, 7.2] Death or HF Hospitalization See Important Safety Information Within. ©2019 Abbott. All rights reserved. AP2947499-US Rev A
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Conclusions In pts with HF and moderate-to-severe or severe secondary MR who remain symptomatic despite maximally-tolerated GDMT, transcatheter mitral leaflet approximation with the MitraClip: Safe, Provided durable reduction in MR, Reduced the rate of HF hospitalizations, Improved survival, Quality-of-life and functional capacity during 24-month follow-up See Important Safety Information Within. ©2019 Abbott. All rights reserved. AP2947499-US Rev A
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Severe Bioprosthetic MV Regurgitation Moderate MR, mitral PG 32 mmHg, Mitral MG 12 mmHg, severe decreased global left ventricular systolic function, EF 25 %, mild AI, moderate TR, Peak PAP 41 mmHg Severe MR, mitral MG 9.3 mmHg Showed transeptal puncture site and height from MV Transthoracic echocardiogram Transesophageal echocardiogram A B
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Final Results Pre-TMVIV replacement TEE Pre-procedural 2D TEE with color Doppler shows severe mitral regurgitation. Post-procedural 2D TEE shows complete resolution of mitral regurgitation after deployment of the 26-mm BE valve. Atrial septal defect from septostomy on TEE with left to right shunt on color Doppler. 3D TEE shows closure of atrial septal defect with 12 mm septal occluder. A B C D ASD from Septostomy on TEE Post-ASD closure 3D TEE Post-TMVIV replacement TEE
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TMVR
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Transcatheter mitral valves of the future
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Structural portfolio TAVR Mitral valve repair and replacement Tricuspid valve repair and replacement PFO/ASD closure LAA closure procedure PVL VSD All percutaneous
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Thank you