China
Africa
Explore chapters and articles related to this topic
Training program guidelines, case numbers, and maintenance of certification
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
In addition to endovascular procedures, the development of percutaneous approaches to the treatment of structural cardiac pathology is rapidly taking place. For years, SHD has been treated in pediatric catheterization laboratories by congenital interventionalists. In adult catheterization laboratories, SHD was traditionally limited to palliative and rescue procedures, such as balloon valvuloplasty and atrial septostomy. More recently, percutaneous closure of patent foramen ovale and atrial septal defects increased in frequency. Percutaneous implantation of bioprosthetic aortic valves, mitral valve annuloplasty and clipping, and left atrial appendage closure has catapulted SHD into the spotlight. Specialty SHD training has become increasingly popular as these techniques have developed. Currently, there are 24 SHD fellowship programs with 29 available positions in the United States.21 All of these programs require completion of adult cardiology and interventional cardiology fellowship training prior to consideration. Further definition of the cognitive and procedural requirements and development of evaluative measures for certification will be required in the near future as this field grows.
Devices in heart failure: new approaches
Published in ILEANA PIÑA, SIDNEY GOLDSTEIN, MARK E DUNLAP, The Year in Heart Failure, 2005
BAcK a R o uNo. To attempt a decrease in ventricular wall stress, transventricular tension members (Myosplint) were implanted to change the left ventricle effective radius and to reduce the left ventricle wall stress by 20%. Myosplints were implanted in seven patients, all diagnosed with dilated cardiomyopathy. New York Heart Association class ranged from Ill to IV, and left ventricular end-diastolic diameter ranged from 70 to 102 mm. Mitral valve regurgitation was classified as mild in three cases and moderate in four. Four patients underwent mitral valve annuloplasty. These investigators observed no significant device-related complications, such as thromboembolism, bleeding, device instability, or vascular damage, at 90 days. Early indications in a small patient population demonstrate some Improvements in clinical parameters. From this initial experience, one may conclude that placement of the Myosplint devices can be safely performed without early, significant adverse events. In patients with significant mitral valve incompetence, concomitant mitral valve repair is indicated to realize the full benefit of the procedure. The long-term effect of each procedure on cardiac function and survival will require further evaluation.
Cardioband system as a treatment for functional mitral regurgitation
Published in Expert Review of Medical Devices, 2018
Adolfo Ferrero Guadagnoli, Carlotta De Carlo, Francesco Maisano, Edwin Ho, Matteo Saccocci, Oscar Cuevas, Marco Luciani, Shingo Kuwata, Fabian Nietlispach, Maurizio Taramasso
Open-heart surgery is the gold standard [2] for the treatment of severe mitral regurgitation (MR). Significant FMR is a frequent finding in heart failure patients with reduced LV ejection fraction, and it is associated with increased morbidity and mortality [3]. Undersized mitral valve annuloplasty (MVA) or valve replacement is the most commonly surgical procedures performed to address FMR. Surgical treatment of FMR has been associated with improvements in symptoms and quality of life [4]. However, in up to 50% of patients with severe MR surgical treatment is not performed owing to increased risk related to comorbidities. The newest technology emerged as an option for those patients. Transcatheter edge-to-edge mitral valve repair with the MitraClip device (MitraClip, Abbott Vascular, Menlo Park, California, U.S.A.) has been used as a less invasive alternative for high surgical patients with symptomatic MR and a high surgical risk.
Transcatheter Annuloplasty for Mitral Regurgitation with an Adjustable Semi-Rigid Complete Ring: Initial Experience with the Millipede IRIS Device
Published in Structural Heart, 2018
Jason H. Rogers, Walter D. Boyd, Thomas W. R. Smith, Adrian A. Ebner, Eberhard Grube, Steven F. Bolling
Seven patients were included in Phase 1 (n = 4) and Phase 2 (n = 3) implants and all received the IRIS ring. Baseline demographics of these patients are shown in Table 1. The average age of the patients treated was 60.3 years, appropriate medical therapy was administered per the local heart team, and all patients were candidates for surgical mitral valve annuloplasty. Only one patient had clinically significant CAD that had been revascularized prior to study enrollment. The first four patients in Phase 1 received the IRIS ring through a conventional open surgical approach, and two of these also received IRIS implants on the tricuspid annulus for associated functional TR and tricuspid annular dilation. When implanting the IRIS in the tricuspid position, one of the anchors was removed before implantation to avoid the AV node. The subsequent three patients in Phase 2 received the transcatheter mitral IRIS rings to the mitral annulus, and their average LVEF was 42 ± 19%. Procedural outcomes are shown in Table 2, and there was no device-related procedural death, stroke, or myocardial infarction (MI). One surgical patient with preoperative chronic kidney disease (CKD) expired on postoperative day 2 after the need for hemodialysis was declined per the family’s request. Retrospectively this patient was excluded from the trial for progressive CKD (an exclusion criterion) which was not disclosed at the time of enrollment.
Left Ventricular Outflow Tract Obstruction Following Mitral Valve Replacement: Challenges for Transcatheter Mitral Valve Therapy
Published in Structural Heart, 2018
Anita W. Asgar, Anique Ducharme, Nathan Messas, Arsene Basmadjian, Denis Bouchard, Michel Pellerin
In the setting of hemodynamic compromise there have been reports of percutaneous alcohol septal ablation performed acutely to reduce LVOT obstruction. Alcohol septal ablation is a transcatheter therapy used for the treatment of LVOT obstruction in patients with hypertrophic cardiomyopathy. This procedure involves the injection of alcohol into septal branches of the left anterior descending artery that perfuse the obstructive segment of the interventricular septum to cause a localized myocardial infarction. This results in a reduction of the LVOT gradient that is similar to surgical septal myectomy at mid-term follow up. Complications of this procedure include permanent heart block in approximately 10% of patients treated.20 Use of alcohol septal ablation was previously described in 2013 to treat LVOT obstruction following mitral valve annuloplasty with success.21 Since that time, individual case reports have described the utility of this procedure to treat acute LVOT obstruction following transcatheter mitral valve-in-mitral annular calcification (MAC) procedures for severe mitral stenosis with successful reduction in LVOT gradients.22,23 A subsequent small series of patients treated with alcohol septal ablation following valve-in-MAC also demonstrated acute improvements in the gradients following the procedure.24 There is now enthusiasm to perform this procedure prior to TMVR in patients considered to be at increased risk for LVOT obstruction post-procedure. Alcohol septal ablation is a simple procedure however is associated with complete heart block, need for permanent pacemaker implantation and malignant arrhythmias25 therefore must be thoughtfully considered prior to recommending this therapy for all TMVR patients.