Paolo FerrazziRozzano 17 aprile 2009 Paolo Ferrazzi Dipartimento Cardiovascolare Ospedali Riuniti Bergamo Ninth International Symposium HEART FAILURE &

Slides:

Advertisements

Similar presentations

Post MI Heart Failure with Left Ventricular Dysfunction Management

Advertisements

HEART TRANSPLANTATION Pediatric Recipients ISHLT 2007 J Heart Lung Transplant 2007;26:

HEART TRANSPLANTATION Pediatric Recipients ISHLT 2008 J Heart Lung Transplant 2008;27:

Assessment of left ventricular function

Cardiovascular Disease In CKD: Is It for Children

Advance Heart Failure Therapy

Mitral Valve Peravalvular (Periprosthetic) Leak. Incidence of Mitral Valve Peravalvular Leak u Reported frequency of % after mitral valve replacement.

Associations between Kidney Function and Subclinical Cardiac Abnormalities in CKD Park M et al. JASN September 2012 Renal Journal Club Oct 2012 BHH Matthew.

CMR of Non-ischemic Dilated and Restrictive Cardiomyopathies

Lecture:10 Contractility, Stroke volume and Heart Failure

Clinical Trial Results. org Valvular Heart Disease and the Use of Dopamine Agonists for Parkinson’s Disease Renzo Zanettini, M.D.; Angelo Antonini, M.D.;

Surgical Risk Dr Chris Snowden MD FRCA Consultant Anaesthetist

Myocardial Repair by Percutaneous Cell Transplantation of Autologous Skeletal Myoblast as a Stand Alone Procedure in Post Myocardial Infarction Chronic.

Perioperative Management of Heart Failure Gamal Fouad S Zaki, MD Professor of Anesthesiology Ain Shams University

A Look Into Congestive Heart Failure By Tim Gault.

Congestive Heart Failure

 Heart failure is a complex clinical syndrome Can result from:  structural or functional cardiac disorder  impairs the ability of the ventricle to.

Widimsky P, Tousek P, Rokyta R, et al. Charles University Prague, CZ PRAGUE-7 Study (Hot Lines presenter)

Mitral valve. Repair vs. Replacement >%80 of MR are repairable Produces more physiological flow states It better preserves LV function Less thrombolic.

Effects of selective heart rate reduction with ivabradine on left ventricular remodelling and function: results from the SHIFT echocardiography substudy.

Manoel Otávio da Costa Rocha UNIVERSIDADE FEDERAL DE MINAS GERAIS - FACULDADE DE MEDICINA PROGRAMA DE PÓS-GRADUAÇÃO EM CIÊNCIAS DA SAÚDE: INFECTOLOGIA.

Mitral valve repair Prof Alain Carpentier is considered the modern day father of MV repair. His publication in the 1980’s called the French correction.

Post-infarction Ventricular Septal Rupture and Free Wall Rupture 서울삼성병원 성균관대학교 김욱성.

1 Cardiac Pathophysiology Part B. 2 Heart Failure The heart as a pump is insufficient to meet the metabolic requirements of tissues. Can be due to: –

Preliminary results from the C-Pulse OPTIONS HF European Multicenter Post-Market Study Holger Hotz, CardioCentrum Berlin, Berlin, Germany; Antonia Schulz,

DIASTOLIC DYSFUNCTION AND HEART FAILURE PHYSIOLOGY, HISTORICAL FEATURES AND CLINICAL PERSPECTIVE Medicine Resident Rounds September 28, 2007 Jacobi Hospital.

Diastolic Dysfunction as Diagnosed and Quantified by Echocardiography LAM-1965AO (07/13) For Broker/Dealer Use Only.

Ventricular Diastolic Filling and Function

BEAUTI f UL: morBidity-mortality EvAlUaTion of the I f inhibitor ivabradine in patients with coronary disease and left ventricULar dysfunction Purpose.

Francesco Liistro Cardiovascular Department, Arezzo, Italy Impact of Thrombus Aspiration on Myocardial Tissue Reperfusion and Left Ventricular Functional.

Treatment of Heart Failure: Beyond Medical Therapy

Current Management of Heart Failure GP clinical update 17 th June 2015 Dr Raj Bilku Consultant Cardiologist Clinical Lead Cardiology QEH.

Rimodellamento Ventricolare e Conversione del Rimodellamento: soni processi confrontabili nei due sessi? Marisa Di Donato IRCCS San Donato Hospital University.

The Relationship Between Renal Function and Cardiac Structure, Function, and Prognosis Following Myocardial Infarction: The VALIANT Echo Study Anil Verma,

Medical Progress: Heart Failure. Primary Targets of Treatment in Heart Failure. Treatment options for patients with heart failure affect the pathophysiological.

Department of Surgery, University of Pennsylvania Health System Which Operation is Best for Severe Ischemic MR: Repair or Replace? Michael Acker William.

Management of Heart Disease in Pregnancy.  It is estimated that 1% to 3% of women either have cardiac disease entering pregnancy or are diagnosed with.

Mitral Regurgitation. Abnormalities of the Mitral Valve Valve Leaflets Chordae Tendineae Papillary Muscles Mitral Annulus.

Adult Cardiac Valve Disease Marvin D. Peyton, M.D. Thoracic and Cardiovascular Surgery University of Oklahoma Health Sciences Center.

Left ventricle Michel Slama Amiens France. LV ventricle Ejection fraction Cardiac output Left ventricular filling pressure.

In the name of GOD 1. Treatment of End Stage Heart Failure Surgical Treatments Cardiac Resynchronization Treatment(CRT) 2.

Adult with operated congenital heart disease: what should we check for? January 15 th, h-17h30.

 By the end of this lecture the students are expected to:  Explain how cardiac contractility affect stroke volume.  Calculate CO using Fick’s principle.

LEFT VENTRICULOPLASTY FOR ENDSTAGE CARDIOMYOPATHY HISAYOSHI SUMA THE CARDIOVASCULAR INSTITUTE TOKYO THE CARDIOVASCULAR INSTITUTE TOKYO.

+ Mitral Valve Prolapse A Surgeon’s Perspective Charles Anderson, M.D. Saint Joseph’s Hospital of Atlanta.

Asymptomatic mitral regurgitation When should you operate? Ben Bridgewater Cardiac surgeon and lead clinician, UHSM, Manchester Honorary Reader, Manchester.

Ten Year Outcome of Coronary Artery Bypass Graft Surgery Versus Medical Therapy in Patients with Ischemic Cardiomyopathy Results of the Surgical Treatment.

Causes of Heart Valve Dysfunction Congenital defects (bicuspid aortic valve) Infections (rheumatic fever and bacterial endocarditis Coronary artery disease.

Extending the Boundaries of TAVR: Future Directions

Heart & Thalassemia . R.Miri,MD, Interventional Cardiologist.

Role of Device Therapy in FMR: Challenges and Opportunities

Pharmacotherapy Of Cardiovascular Disorders: Heart Failure

Management of mitral regurgitation. See legend for Fig

Mitral Regurgitation: Epidemiology, Pathophysiology and When to Repair

Cardiothoracic Surgery

University of Pennsylvania Philadelphia

DIASTOLIC DYSFUNCTION and DIASTOLIC HEART FAILURE

Dr M B Connellan Stellenbosch University

Normal physiology (control) is compared to that of acute mitral regurgitation (chordal rupture), compensated mitral regurgitation, and decompensated chronic.

Cardiovacular Research Technologies

The American Heart Association

Erratum Heart Rhythm Volume 8, Issue 4, (April 2011)

Zoll Firm Lecture Series

Johannes Steiner et al. JACC 2017;70:

Douglas L. Mann, MD, Michael A. Acker, MD, Mariell Jessup, MD, Hani N

Congestive heart failure: Treat the disease, not the symptom

Implication of right ventricular dysfunction on long-term outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting.

Patrick O’Gara et al. JIMG 2008;1:

Rick A. Nishimura et al. JACC 2017;70:

VEVO 3100 Mouse Cardiovascular Core Division of Cardiovascular Disease Department of Medicine, University of Alabama at Birmingham Core director: Ganesh.

Presentation transcript:

Paolo FerrazziRozzano 17 aprile 2009 Paolo Ferrazzi Dipartimento Cardiovascolare Ospedali Riuniti Bergamo Ninth International Symposium HEART FAILURE & Co. Rozzano,April 17, 2009 What Can the Surgeon Do to Avoid Heart Replacement?

Paolo FerrazziRozzano 17 aprile 2009 DIABETES Valvular Disease HEART FAILURE SURGERY Cardiomyopathies Delayed Primary PTCA Myocardial Infarction Hypertension End Stage HF (10%)

Paolo FerrazziRozzano 17 aprile 2009 HTx 344/yrs VAD 30/yrs Conventional Surgery n° ? End Stage Heart failure ISCHEMIC HYPERTENSIVE VALVULAR IDIOPATIC Surgical Treatment of Heart Failure in Italy

Paolo FerrazziRozzano 17 aprile 2009 ICM worse results then DCM!!! ICM worse results then DCM!!! Heart Failure Surgical Options Heart Transplant VAD (recovery, continuous flow) Mitral annuloplasty

Paolo FerrazziRozzano 17 aprile 2009 Sugical Treatment of Heart Failure Substitutive Surgery –Transplantation: shortage of donors –VAD: cost, management, complications Reconstructive Surgery –SVR + CABG (STICH Results) –No basic research

Paolo FerrazziRozzano 17 aprile 2009

Paolo FerrazziRozzano 17 aprile 2009 STICH Results Comparison CABG vs SVR + CABG instead of HTx vs SVR + CABG in a sub-class of patients –VO 2 max and right catheterization not available In more experienced Centers: exclusion from randomization of patients with a strong indication to SVR Regional differences in surgical results –SVR long tradition? Inadeguate mean ESV reduction (-19%) in SVR patients Personal Opinions

Paolo FerrazziRozzano 17 aprile 2009

Paolo FerrazziRozzano 17 aprile 2009 SVR & diastolic function Animal study Clinical follow-up Mathematical model Post-op ECHO study DIASTOLIC FUNCTION SYSTOLIC FUNCTION Systolic improvement is paid by some diastolic dysfunction … presented for the first time in 2000!

Paolo FerrazziRozzano 17 aprile 2009 Passive Diastolic Function ….a black hole in echocardiography Systolic FunctionEarly DiastoleLate Diastole Fractional shortening Vcf Stress-corrected Vcf Ejection fraction Tei index Strain and strain rate TDI S-wave E/A ratio DT msec IVRT msec PV S/D ratio TDI-E/E

Paolo FerrazziRozzano 17 aprile 2009 Clinical Research SVR ….. thinking to diastolic function: The horseshoe repair Potential Advantages Horseshoe repair Volume EqD Eccentricity index Stroke volume Late diastolic function Ferrazzi, et al JTCVS 2008

Paolo FerrazziRozzano 17 aprile 2009 Apr Dec 2008 n pts 34 Age (mean)59.07±8.9 Mitral repair 21 pts (61%) Follow-up (mean)16±10.3 mo Hosp. Mortality2 pts (5.8%) Fu mortality2* *1 pneumonia after 4 mo and 1 sudden death after 2 mo SVR – HORSESHOE REPAIR 84.1± ±13.4Ø Longitudinale (mm) ± ±5.5Ø Equatoriale (mm) ±29.3 (- 44%) 174.0±56.3 VTSV sn (ml) ± ±0.2 NYHA P-value Follow-up Preop ± ±5.7 FE (%) 0.002

Paolo FerrazziRozzano 17 aprile 2009 Experimental Research The Endoventricular Elastic Devices Restore the elasticity of the dilatated heart Reduce left ventricle volume Store wasted energy during the diastolic phase Give the stored energy back during the sistolic phase Ferrazzi, et al J Cardiovasc Med 2006

Paolo FerrazziRozzano 17 aprile 2009

Paolo FerrazziRozzano 17 aprile 2009 COMPLEX PATHOPHYSIOLOGICAL MECHANISM OF FUNCTIONAL MITRAL INCOMPETENCE Ischemic Heart Failure VALVE PAPILLARY MUSCLES LEFT VENTRICLE

Paolo FerrazziRozzano 17 aprile 2009

Paolo FerrazziRozzano 17 aprile 2009 Work in progress...

Paolo FerrazziRozzano 17 aprile 2009 Current Practice: One size fits all ! Cardiac surgery Surgical TrialPersonalized surgery

Paolo FerrazziRozzano 17 aprile 2009 HEART FAILURE GENOMICS & BIOLOGY ANATOMY & GEOMETRY PHYSIOLOGY BIO ENGINEERING Heart Failure: back to surgical research...