Hở van hai lá do thiếu máu cơ tim có gì mới năm 2014

Ischemic Mitral Regurgitation: What we can in 2014 Peter M Pollak MD ©2011 MFMER | 3138928-1 Disclosure Relevant Financial Relationship(s) • None Off Label Usage • None ©2012 MFMER | 3208595-2 What we can in 2014… Understand IMR Better Medical Therapy Percutaneous Therapies Surgical Therapy • Clinical Significance • Pathophysiology & Mechanism • ACE Inhibitors • Beta Blockers • Cardiac Resynchronization Therapy • MitraClip • Valve Repair vs Replacement • CABG/Revascularization ©2011 MFMER | 3138928-3 MR decreases survival after diagnosis Copyright © American Heart Association, Inc All rights reserved Grigioni F et al Circulation 2001;103:1759-1764 Worse Ischemic MR Worse Long-Term Survival 100 No MR 80 % 61±6 60 ERO[...]... Tischler AJC 1998 ©2011 MFMER | 3138928-11 Medical Therapy Effect from Heart Failure Reference Trials McDonagh ESC 2014 ©2011 MFMER | 3138928-12 CRT improves Ischemic MR • Temporary effect during CRT • MR returns when CRT off Van Bomel CIRC 2011 ©2011 MFMER | 3138928-13 Response to CRT correlates with survival Van Bomel CIRC 2011 ©2011 MFMER | 3138928-14 MitraClip Device ©2011 MFMER | 3138928-15 MitraClip... Ischemic MR ERO >0.4cm2 12 month follow-up • Prospectively randomized to: • (1) Mitral Valve Repair with ring annuloplasty • (2) Chordal-sparing Replacement • 75% had concomitant CABG • Results: no difference in death or composite endpoint • Higher recurrence of MR with repair (32% vs 2%) ©2011 MFMER | 3138928-20 Acker MA et al N Engl J Med 2014; 370:23-32 Summary • Ischemic MR is a myocardial problem