Ασθενής 81 ετών με σοβαρή ανεπάρκεια μιτροειδούς και τριγλώχινας

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1 Ασθενής 81 ετών με σοβαρή ανεπάρκεια μιτροειδούς και τριγλώχινας

2 Disclosures - Proctoring activities for Abbott Vascular, Edwards Lifesciences I and the HYGEIA Hospital «Heart Team» have received research and/or travel grants and/or lecture fees from: - ABBOTT Vascular, Europe, Edwards Lifesciences, Medtronic HYGEIA Hospital Heart Team Cardiologists: G. Kourkoveli, K Papadopoulos, A Halapas, M Chrissoheris, N. Georgakopoulos, K Spargias CT Surgeons: N Bouboulis, G. Pattakos, S Skardoutsos, A Tsolakis, S Pattakos Anesthesiologist: N.Papanikolaou, I Nikolaou Pediatric and Adult Congenital Cardiology: A Tzifa Vascular Surgeons: I Belos, S Kaliafas Radiologists: F Laspas, C Mourmouris Electrophysiology: L Papavassiliou, S. Kourouklis, G Zervopoulos, T Apostolopoulos Research Nurse: E. Dafnomyli

3 The Patient 81 year-old male, NYHA III, mostly right sided HF, on maximal medical therapy Degenerative mitral regurgitation (A2 prolapse), at least moderate (ERO 30mm 2 )

4 Degenerative Mitral Regurgitation

5 Moderate to Severe Mitral Regurgitation

8 Mitral Valve Analysis

9 The Patient 81 year-old male, NYHA III, mostly right sided HF Degenerative mitral regurgitation, at least moderate Severe tricuspid regurgitation, right ventricular dilatation, RV dysfunction, severe pulmonary hypertension (up to 60mmHg)

10 Severe Functional Tricuspid Regurgitation

13 The Patient 81 year-old male, NYHA III, mostly right sided HF Degenerative mitral regurgitation, moderately severe (ERO 30mm 2 ) Severe tricuspid regurgitation, right ventricular dilatation Coronaries no stenoses Comorbidities: Chronic AF, chronic lung disease / restrictive

15 Πώς θα προχωρήσουμε? Α. Χειρουργική επιδιόρθωση / αντικατάσταση μιτροειδούς και επιδιόρθωση τριγλώχινας Β. Διακαθετηριακή επιδιόρθωση μιτροειδούς με MitraClip λόγω της προχωρημένης ηλικίας και συντηρητικά με την τριγλώχινα (μπορεί και να βελτιωθεί μετά την επιδιόρθωση της μιτροειδούς) Γ. Διακαθετηριακή επιδιόρθωση μιτροειδούς με MitraClip και επίσης προσπάθεια και για επιδιόρθωση της τριγλώχινας Δ. Φαρμακευτική μόνο αγωγή, συντηρητικά λόγω της ηλικίας

16 Heart Team Discussion Degenerative mitral regurgitation and severe functional tricuspid regurgitation High risk surgery due to advanced age, need for mitral valve replacement and tricuspid annuloplasty Decision for transcatheter edge to edge mitral valve repair MitraClip Also transcatheter tricuspid valve edge to edge repair with MitraClip

expectancy but who have a prohibitive surgical risk because of severe comorbidities and remain severely

17 Transcatheter mitral valve repair may be considered for severely symptomatic patients (NYHA class III to IV) with chronic severe primary MR (stage D) who have favorable anatomy for the repair procedure and a reasonable life expectancy but who have a prohibitive surgical risk because of severe comorbidities and remain severely symptomatic despite optimal GDMT for HF (Level of Evidence: B) Degenerative / Primary Mitral Regurgitation: Guidelines for MitraClip

19 Interventional Tricuspid Valve Therapies: The TriValve Registry

20 MitraClip for the Tricuspid Valve A S P P S A

27 Final Mitral Valve after 1 MitraClip

28 Mitral Valve after MitraClip: Reduction in MR

40 Hospital Course ICU stay for 24hrs Discharge home on day #4 post procedure Clinical improvement at the 3 month follow up

41 In Summary In octogenarians (patients years old) with degenerative mitral regurgitation consider transcatheter repair with MitraClip Safe, less traumatic, faster return to daily activities, no loss of independence Combined transcatheter mitral and tricuspid valve repair is feasible with use of the edge to edge method Anticipate results of further clinical studies and improvements in imaging for the tricuspid valve

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