Mot so tien bo trong
TIM MACH CAN THIER BENH CAU TRUC TIM
PGS.TS.BS Pham Manh Hung
Tổng thư ký - Hội Tim Mạch Học Việt Nam
Trang 2Một số tiến bộ mới trong can thiệp bệnh tim cấu trúc
‹ Một sô bệnh tim bắm sinh phức tạp
¢ Thay van DMC qua da ¢ Suwa van hai lá qua da
Trang 3Tổng số bệnh nhân đựợc làm
thủ thuật tim mạch can thiệp tai
Viện Tim Mạch - Bệnh viện Bạch Mai
Từ 1997 - đến hết 9/2014
65 748 lượt bệnh nhân
Trang 11NGUYEN THI MINH, HANG, 1111103.13265, 25/08/1978, F 15 fps 3¥ Truong Dai Hoc YHa Noi NGUYEN THI MINH, HANG, 1111103.13265, 25/08/1978, F 15 fps 3V Truong Dai Hee Y Ha Hoi Run 1- Frame 1/37 KH, 2 lo dua xi 1/0 lào 65.8kV, mÃs, 8m4, - s
Zoom 121% Zoom 121%
Trang 12Bít lỗ thông liên thât băng dụng cụ
Trang 13Bít lỗ thông liên thât băng dụng cụ
Trang 16Đóng rò ĐMV qua đường ống
Trang 17Can thiệp các bệnh ly van
Trang 18Các can thiệp thường quy
e Nong hep van hai la qua da bang bóng
¢ Nong hep van DMC bam sinh
Trang 20Các can thiệp hiện đại
e Thay van qua Ong thong:
Trang 23Ca LS thay van ĐMC qua đường
Trang 25Cardiovascular Mortality (ITT)
Trang 26Survival
Distribution
Corevalve ADVANC | 1 vear Survival
Trang 28Chỉ định mới về TAVR (AHA/ACCF 2014)
Recommendations COR | LOE
Surgical AVR is recommended in patients who
meet an indication for AVR (listed in Section 3.4) with low or intermediate surgical risk
For patients in whom TAVR or high-risk surgical AVR is being considered, members of a Heart Valve Team should collaborate closely to provide
optimal patient care
TAVR is recommended in patients who meet an indication for AVR for AS who have a prohibitive Surgical risk and a predicted post-TAVR survival
>12 months
Pe XS csi Resi ;
\ Ư N BÀ - Hoijping CarlioUascular Profesionab é American
Learn Advance Heal Heart
Trang 29Chỉ định mới về TAVR (AHA/ACCF 2014)
Recommendations COR | LOE TAVR Is a reasonable alternative to surgical
AVR for AS in patients who meet an indication B for AVR and who have high surgical risk
Percutaneous aortic balloon dilation may be
considered as a bridge to surgical or C transcatheter AVR in severely symptomatic
patients with severe AS
TAVR is not recommended in patients in whom
the existing comorbidities would preclude the B expected benefit from correction of AS
Ehlbin Gullurugtl TrưEatub american
Learn Advance Heal Heart
Trang 31Kỹ thuật sửa van hai lá qua ống thông
Trang 32y
Thay van DMP qua duong ông
Trang 34Ca bệnh nhân đâu tiên can thiệp
Trang 37Worldwide MitraClip Experience
EVEREST | (feasibility) Feasibility 55
EVEREST II (pivotal) Roll-in 60
EVEREST II (pivotal) Randomized 184
EVEREST II (pivotal) Non-randomized high-risk 78
REALISM continued access Non-randomized ö99
Compassionate/emergency Non-randomized 66 ACCESS Europe Phase | Non-randomized 567 ACCESS Europe Phase II Non-randomized 286 Commercial Use Commercial 11,864
Total l2
Trang 40Transcatheter MV Repair: Device Landscape 2014
Edge-to-edge Coronary sinus Other
° MitraClip annuloplasty approaches
¢ MitraFlex ¢ Cardiac Dimensions Carillon ¢ MitraSpacer
Direct annuloplasty ¢Cerclage annuloplasty › St Jude leaflet plication
MV replacement + NeoCniore
and basal | ¢ Cardiac Implant perc ring
ventriculoplasty Bec C Ti
° Mitralign Bident cà 99/8907 ° Valtech Vchordal
- GDS Accucinch “ - Middle Peak Medical
- Valtech Cardioband 7 TaNdyna" - Mardil BACE
Trang 41Device Landscape - Failures Transcatheter MV Repair
Edge-to-edge Coronary sinus Direct annuloplasty
¢ Edwards Mobius annuloplasty ¢ Cordis DPA
Trang 42Mitral Annuloplasty Systems Under current development
Cardiac Dimensions Carillon Indirect annuloplasty Coronary sinus cinching Mitralign TAMR GDS Accucinch Valtech Cardioband
- Trans-aortic - Basal - Trans-septal
- LV implant of 1-3 ventriculoplasty - LAimplant of a posterior annular pairs of - LV implant of annulus band
Trang 43Khuyên cáo can thiệp sửa van hai lá qua
đường ông thông
Recommendations COR | LOE
Percutaneous MV repair may be considered for severely symptomatic patients (NYHA class III-
IV) with chronic severe primary MR (stage D) who have a reasonable life expectancy, but a
prohibitive surgical risk because of severe comorbidities
MVR should not be performed for the treatment of isolated severe primary MR limited to less than one half of the posterior leaflet unless MV repair has been attempted and was
unsuccesstul
4G b2 c > -
\ Ư N BÀ - Hoijping CarlioUascular Profesionab é American
Learn Advance Heal Hear t
Trang 44Phong can thiệp tích hợp phòng mồ — Cath Lab ˆ
Trang 45Kết luận " Tim mạch can thiệp câu trúc tim đã có những tiễn bộ không ngừng, hiệu quả ngày một cao, ứng dụng ngày cảng rộng rãi
“ Tương lai cua TMCT rong mo,
tuy vay lu6n can co sw phat trién đồng bộ của “bộ ba”: Nội khoa —