JIM Today 2018 - Friday - page 5

Issue 2 
Friday
 23 February 2018 
JIM today
5
A masterclass in solving dilemmas in
interventional mitral valve procedures
T
he very exciting, burgeoning
era of interventional mitral
valve replacement will be ad-
dressed this afternoon, with Hendrik
Treede, the Director and Chairman of
the Mid-German Heart Center at the
University Hospital Halle in Germany,
taking to the podium to share his
perspectives. “It’s such an important
problem because today we see the
development of interventional repair
technologies as well as replacement
technologies for functional mitral
regurgitation,” he said. “Repair we
have had for some years, but we are
at the very beginning of what some
people think is a new era in tran-
scatheter heart treatment.”
Interventional therapies are
proving to be a huge development
for patients with functional mitral
regurgitation (FMR), Professor Treede
said in conversation with
JIM Today
.
“This is such a huge development
because there are so many patients
who suffer from functional MR, and
many of them are very sick and not
good surgical candidates,” he said.
“They deserve a good catheter-based
technology, and I’m very happy to
see that more technologies are being
developed. It’s really a relief for pa-
tients.”
In his presentation later today, Pro-
fessor Treede – who has a long pedi-
gree in mitral valve surgery, as well
as interventional procedures – will
offer an interactive exploration of the
practical ways in which patients can
be selected. “There are some param-
eters I will name and discuss with the
audience and potentially parameters
to look for when you want to decide
between repair and replacement in
functional mitral valve regurgitation,”
he explained. “I want to provoke
discussions, to give my opinion, and
see what the audience thinks.”
Because there is still little data
available on interventional approach-
es, Professor Treede suggested that
we look to surgical experiences for
guidance – albeit taking into account
that there is still some ambiguity there
as well: “In surgery, for many years
we’ve had repair as well as replace-
ment technologies, but one has to
say that in the field of functional
mitral regurgitation, even with
surgery it wasn’t always 100%
clear which patients needed a
valve replacement, and which
patients needed repair.”
One 2014 study in the New
England Journal of Medicine looked
at this issue in patients with func-
tional mitral regurgitation in ischemic
CMP.
1
“They demonstrated that
those patients with a successful repair
showed left ventricular recovery, while
those who showed recurrence of MR
after repair did much worse. Here
replacement was even better,” he
explained. “That was somehow the
starting point of the discussions for
functional MR, i.e. when should we
repair, and when should the mitral
valve be replaced?”
Looking to studies focused on
surgery, Professor Treede said that
there are some useful parameters
that may be applied to the interven-
tional space. Specifically, he noted
that these parameters might have
power in informing when a mitral
valve can still be repaired, or rather
when replacement is really mandated.
As such, he added, it is now time to
reach consensus on interventional
mitral valve procedures.
Turning to the specific parameters
he will focus upon, Professor Treede
continued: “If we look at tenting of
leaflets in FMR, a tenting height of
more than 1 cm turns out to be a pre-
dictor of an unsuccessful repair, and
therefore points towards a need for
replacement. It is not only the tenting
height but also the tenting symmetry.
If the stenting is very symmetric, then
replacement should be considered,
but if it’s asymmetric, that could
speak for repair. Other parameters to
look for are left ventricular volumes
and sphericity index.”
References
1. Acker M et al; Mitral-Valve Repair versus
Replacement for Severe Ischemic Mitral Regur-
gitation. N Engl J Med 2014; 370:23-32
Structural heart 2 
Porta 
Friday 
12:45
“Repair we have
had for some years,
but we are at the
very beginning of
what some people
think is a new era in
transcatheter heart
treatment.”
Hendrik Treede
“There are some parameters
I will name and discuss with
the audience and potentially
parameters to look for when
you want to decide between
repair and replacement
in functional mitral valve
regurgitation.”
Hendrik Treede
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