functional mitral regurgitation requires both a mitral · pdf filefunctional mitral...
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Gregory P. Fontana, M.D., FACC, FACS
National Medical Director for Cardiovascular Research And Innovation
Hospital Corporation of America
Medical Director for Cardiovascular Research
Sarah Cannon Research Institute
Director and Chairman
Cardiovascular Institute of Los Robles Hospital and Medical Center
Functional Mitral Regurgitation Requires Botha Mitral and a Ventricular Solution
Func tio na l MR is a VENTRIC ULAR Dise a se !
In No nisc he m ic a nd isc he m ic c a rd io m yo p a th ie s, g e o m e tric p e rturb a tio ns in the
le ft ve ntric le (LV) re sult in d ysfunc tio n o f the Mitra l Va lve a nd se c o nd a ry
(func tio na l) m itra l re g urg ita tio n (FMR).
An inc re a se in the in te rp a p illa ry d ista nc e , a nnula r d ila tio n, a nd e nha nc e d le a fle t
te the ring c o ntrib ute to se c o nd a ry MR.
THE VALVE ARC HITEC TURE IS NO RMAL
Surg ic a l The ra p y a nd Func tio na l Im p ro ve m e nt
C o sg ro ve 2000
Im p ro ve d NYHA fro m 2.8 to 1.2
Re d uc e d Re a d m issio ns fo r He a rt Fa ilure
Pa tie nts to le ra te d hig he r d o se s o f Me d ic a l The ra p y
Ba d w a r a nd Bo lling 2002
4+ MR a nd Lo w EF (m e a n 14%)
NYHA 3.9 to 2.0
Ro m a no a nd Bo lling 2004
O ve r 200 p a tie nts
Im p ro ve d NYHA C la ss fro m 3.2 to 1.8
De Bo nis, Alfie ri 2005
Im p ro ve d NYHA 3.4 to 1.4
Ac ke r (Ac o rn Tria l) 2006
Be tte r Func tio na l C la ss, MLHF, Sho rt-fo rm 36, 6 m inu te w a lk
Date of download: 2/10/2016 Copyright © The American College of Cardiology. All rights reserved.
What is the Impact of mitral valve annuloplasty on mortality risk in patientswith mitral regurgitation and left ventricular systolic dysfunction?
Wu, Bolling, et al, J Am Coll Cardiol. 2005;45(3):381-387. doi:10.1016/j.jacc.2004.09.073
Event-free survival for non-mitral-valve annuloplasty (MVA) group (solid line)and MVA group (dotted line).
Lack of Survival Benefit!
N=419
Date of download: 2/10/2016 Copyright © The American College of Cardiology. All rights reserved.
What is the impact of mitral valve annuloplasty on mortality risk in patients withmitral regurgitation and left ventricular systolic dysfunction?
Wu, Bolling, et al, J Am Coll Cardiol. 2005;45(3):381-387. doi:10.1016/j.jacc.2004.09.073
Event-free survival for patients without coronary artery disease in non-mitral-valve
annuloplasty (MVA) group (solid line) and MVA group (dotted line).
Double-orifice technique: A simple solution for complex problems
Ottavio Alfieri, MD, Francesco Maisano, MD, Michele De Bonis, MD, Pier Luigi Stefano, MD, Lucia Torracca, MD, Michele Oppizzi, MD, Giovanni LaCanna, MD
The Journal of Thoracic and Cardiovascular SurgeryVolume 122, Issue 4, Pages 674-681 (October 2001)
Fre e d o m fro m re c urre nc e o f MR o f g ra d e 3 to 4+ in the e d g e -to -e d g e a nd in thering -o nly g ro up s.
Michele De Bonis et al. Circulation. 2005;112:I-402-I-408
Copyright © The American College of Cardiology. All rights reserved.
From: Randomized Comparison of Percutaneous Repair and Surgery for MitralRegurgitation: 5-Year Results of EVEREST II
J Am Coll Cardiol. 2015;66(25):2844-2854. doi:10.1016/j.jacc.2015.10.018
Original Article
Two-Year Outcomes of Surgical Treatment of SevereIschemic Mitral Regurgitation(MV Repair vs Replacement)
Daniel Goldstein, M.D., Alan J. Moskowitz, M.D., Annetine C. Gelijns, Ph.D., GoravAilawadi, M.D., Michael K. Parides, Ph.D., Louis P. Perrault, M.D., Judy W. Hung, M.D.,
Pierre Voisine, M.D., Francois Dagenais, M.D., A. Marc Gillinov, M.D., VinodThourani, M.D., Michael Argenziano, M.D., James S. Gammie, M.D., Michael Mack, M.D.,Philippe Demers, M.D., Pavan Atluri, M.D., Eric A. Rose, M.D., Karen O’Sullivan, M.P.H.,
Deborah L. Williams, B.S.N., M.P.H., Emilia Bagiella, Ph.D., Robert E. Michler, M.D.,Richard D. Weisel, M.D., Marissa A. Miller, D.V.M., Nancy L. Geller, Ph.D., Wendy C.
Taddei-Peters, Ph.D., Peter K. Smith, M.D., Ellen Moquete, R.N., Jessica R.Overbey, M.S., Irving L. Kron, M.D., Patrick T. O’Gara, M.D., Michael A. Acker, M.D., for
the CTSN
N Engl J MedVolume 374(4):344-353
January 28, 2016
Time-to-Event Curves for Major Adverse Cardiac or Cerebrovascular Events (MACCE).
Goldstein D et al. N Engl J Med 2016;374:344-353
C um ula tive Fa ilure o f Mitra l-Va lve Re p a ir o r Re p la c e m e nt.
Goldstein D et al. N Engl J Med 2016;374:344-353
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