Dynamic Mitral Valve Ring Annuloplasty Micardia Concept Maurice
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Dynamic Mitral Valve Ring Annuloplasty: Micardia Concept Maurice Buchbinder, MD Foundation for Cardiovascular Medicine La Jolla, CA Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
DISCLOSURES Maurice Buchbinder, MD Honoraria – Boston Scientific Corporation, Cordis, a Johnson & Johnson company, Abbott Vascular
Disclosure. Stents? Why Degradable Speaker’s name: Maurice Buchbinder, MD I have the following potential conflicts of interest to report: Micardia Inc Consulting Employment in industry Stockholder of a healthcare company Scientific Advisory, Board Member I do not have any potential conflict of interest Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
Ischemic MR • Ischemic Mitral Regurgitation (IMR) is seen in up to 20% of patients following acute myocardial infraction. (Hickey; Circulation 1988; 78: 151 -159, Lamas; Circulation 1997; 96: 827 -833) • Treatment of IMR includes medical therapy and in severe cases surgical repair with an undersized annuloplasty ring to reduce the size of the mitral annulus and improve leaflet coaptation. Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
Ischemic MR • Following isolated annuloplasty surgery recurrent (>2+) MR is seen in 10 -30% of patients (Mc. Gee; J. Thorac Cardiovasc Surg 2004; 128: 916 -24) • Recurrent MR appears to be commonly seen within the first year following surgery and remains relatively stable thereafter (Mc. Gee; J. Thorac Cardiovasc Surg 2004; 128: 916 -24) • Unlike in dilated cardiomyopathy IMR is associated with asymmetric deformation of the annulus (Kwan; Circulation. 2003; 107: 1135. ) Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
Current technology does not cope with dynamic ischemic disease • Residual post-op occurrence 6 -10% Edwards Physio • 6 month, recurrence 15%-25% Medtronic Duran • 3 Years, recurrence 30% to 50% SJM Tailor ATS Simulus Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
Mi. Cardia Semi-Rigid Dynamic Annuloplasty “C” Ring (Degenerative) Baseline Shape (Implanted) Transparent = Baseline Red = Post Activation Shape Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
Mi. Cardia Rigid Dynamic Annuloplasty “D” Ring (Ischemic) Baseline Mi. Cardia Dynamic Ring Transparent = Baseline Red = Activated Shape Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
The Mi. Cardia Dynamic Ring • Available in “C” and “D” shape sizes 28 mm through 36 mm • Without activation functions as a “standard” ring • Pre-attached electrodes used for activation make the ring Dynamic Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
Intra-Operative Re-shaping • Each RF wire is connected to the propriatary Mi. Cardia RF generator. • Following implantation, Wires are activated as needed to reshape the ring in vivo • Echocardiography confirms effectiveness of activation during and post re-shaping Maurice Buchbinder, MD Foundation for Cardiovascular Medicine P 1 P 3 P 2
Dynamic Ring - Features • Implants identical to existing technology • Semi-rigid metal core maintains its shape. Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
Dynamic Ring - Activation • Can be reshaped intraoperatively by the operating Surgeon • Or at a later date upon recurrence of MR using percutaneous techniques. Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
Intra-Operative Reshaping Pre-clinical “In-Vivo” experience Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
Intra-Operative Reshaping Pre-clinical “In-Vivo” experience • A-P distance shortening by 0. 5 -3. 0 mm • Inter-Commissural distance contracted by 1. 0 -3. 5 mm • No heat damage to the surrounding tissue Postero-Medial commissure activation Courtesy Dr. Alex Marmureanu Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
Ring Activation Pre-Activation Maurice Buchbinder, MD Foundation for Cardiovascular Medicine Intra-Op Activation
Ultimate Valve Repair Modality Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
Percutaneous Reshaping: Q Device Platform Sub- • Single lead, atrial exit • No flow interference • Subcutaneous “pocket“ deployment of lead • Simple outpatient activation • Activate days, weeks or months after the initial procedure to correct recurrence Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
Percutaneous Reshaping: Sub. Q Device Platform @140 days Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
Percutaneous Reshaping: Sub. Q Device Platform @140 days Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
Percutaneous Reshaping: Sub. Q Device Platform @140 days Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
Percutaneous Reshaping: Sub. Q Device Platform @140 days Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
Post-Activation Maurice Buchbinder, MD Foundation for Cardiovascular Medicine PRE-Activation
Percutaneous Reshaping: Sub. Q Device Platform @140 days • Full activation within 60 seconds Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
140 days post implant Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
Percutaneous Reshaping: Sub. Q Device Platform @140 days • No infection • No dehiscence • Full activation @ 140 days, despite 100% ingrowth Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
Human Experience Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
39 Human Implants Completed 34 DYANA study patients treated in Europe and 5 in the US Site Implants Activations University Hospital of Homburg 7 4 Leipzig University Heart Center 11 1 Sana Herzchirurgie, Stuttgart 8 2 University Hospital, Keil 4 0 William Beaumont Hospital 5 N/A Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
TTE 2 D pre-procedure Bi-leaflet Prolapse Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
TTE 4 -chamber Pre-procedure Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
TTE 4 -chamber post ring implant prior to activation Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
TTE 2 -chamber post ring implant prior to activation Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
RF connecting cable in place Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
TEE 3 -chamber Post-activation Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
TTE apical 4 -chamber prior to discharge Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
PRE- Procedure TTE Maurice Buchbinder, MD Foundation for Cardiovascular Medicine Post-Procedure TTE
6 -Month F/U, TTE 4 -chamber Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
Conclusion • From this early clinical experience the Mi. Cardia Dynamic Annuloplasty Ring appears to be a promising device for the surgical treatment of Mitral regurgitation. • The In-Vivo adjustable feature may be an extremely valuable tool for optimization of surgical results • Further minimally invasive adjustments in ring geometry in the healing phase could be a compelling advantage for its use. • Clinical studies are ongoing. Maurice Buchbinder, MD Foundation for Cardiovascular Medicine
- Maurice buchbinder md
- Tendyne
- Apical pulse and mitral valve
- Pht mitral valve
- Pht mitral valve
- Mechanical servo valve
- Ring christmas bells ring them loud
- Ductus deferens inguinal canal
- Inner ring and outer ring
- Internal ring
- Token ring and resilient packet ring
- Anions
- Ring christmas bells ding dong
- Constriction ring uterus
- Tendinous cords
- Valvula mitral
- Mitral stenosis measurements
- Define mitral stenosis
- Valva mitral
- Score wilkins estenosis mitral
- Bedana ritmi
- Mitral stenosis chest x ray
- Estenose mitral
- Orttirilgan yurak poroklari
- Pathophysiology of valvular heart disease
- Aortic regurgitation murmur
- Valvula mitral en paracaidas
- Mitral facies pathophysiology
- Rhumatic fever criteria
- Choc de pointe en dôme de bard
- Pistol shot bulgusu
- Lvvo heart
- Mitral stenosis pulmonary hypertension
- Heart sounds location
- Mitral stenosis chest x ray
- Mitral facies
- L
- Ducto toraxico