Edwards Cardioband Mitral System Echo Guidance: anatomy and physiology

Transcription

1 Edwards Cardioband Mitral System Echo Guidance: anatomy and physiology EuroPCR 2017 Ralph Stephan von Bardeleben Universitätsmedizin Mainz Germany Information not intended for use in France. Lotus is an investigational device and not for sale or distribution in the US. CE mark received Information for the Lotus Valve System is for use in countries with applicable product registrations. Indications, contraindications, warnings and instructions for use can be found in the product labeling supplied with each device.

2 Edwards Cardioband TM Mitral Repair System Step by step approach Venous puncture Transseptal puncture (CT preplanned) TS Sheath positioning GC positioning near LAA at landing zone GC and anchor repositioning (MPR/FlexiSlice) Cinching and MR assessment ECHO guided ECHO guided ECHO guided ECHO guided ECHO guided

3 Cardioband Procedural Steps 1 Transseptal Puncture 2 System Insertion 3 Implant Deployment 4 Implant Size Adjustment

4 Edwards Cardioband - FMR Pre Procedure Procedure von Bardeleben, RS Mainz

5 TEE Views and Anatomic Correlate LA SVC Ao PV AoV RA Short Axis View Fossa RV Bi-Caval View IVC SVC IVC RA Courtesy Grayburn

6 TEE Views and Anatomic Correlate SVC Ao PV Four-Chamber View Fossa RV LA IVC RA RV LV Courtesy Grayburn

7 Edwards Cardioband Transseptal MPR MultiPlanarReconstruction FlexiSlice Procedure von Bardeleben, RS Mainz

8 Edwards Cardioband Mitral Repair Procedure LA von Bardeleben Universitätsmedizin Mainz

9 Edwards Cardioband - Initial Anchors Procedure von Bardeleben, RS Mainz

10 Edwards Cardioband - Classic 2D Echo Analysis Initial Anchors LAA vs Hinge Procedure von Bardeleben, RS Mainz

11 Anchor Implantation and Cinching A B C D

12 A Implant Technique B C D

13 Procedural Echo guidance standardize and simplify echo guidance during implant Universitätsmedizin Mainz introduced using MPR or FlexiSlice. It allows to capture a high quality 3D volume and work with the same volume for long sessions reducing the image acquisition time. Changing the section of interest is performed by rotating the axes on the screen rather than manipulating the TEE probe making the process more structured and fast ( min)

14 Edwards Cardioband - MPR MultiPlanarReconstruction FlexiSlice Procedure von Bardeleben, RS Mainz

15 Edwards Cardioband - MPR MultiPlanarReconstruction FlexiSlice Visibility of Anchors in Echo! Procedure von Bardeleben, RS Mainz

16 Edwards Cardioband - MPR MultiPlanarReconstruction FlexiSlice Procedure von Bardeleben, RS Mainz

17 Edwards Cardioband - MPR MultiPlanarReconstruction FlexiSlice Procedure von Bardeleben, RS Mainz

18 3D TEE of Cardioband After Cinching

19 3D TEE Images Pre-, During, Post-Procedure Edwards Cardioband Mitral System Baseline (pre-device) Device Pre-Cinching Device After Cinching A B C

20 Edwards Cardioband Mitral - Cinching Effect Assessment Final Echo Control No Gradients Procedure von Bardeleben, RS Mainz

21 Edwards Cardioband - FMR Post Procedure Procedure von Bardeleben, RS Mainz

22 Edwards Cardioband Mitral Repair - Echo Guidance Take Home Message Heart Implant Team: Communication between Interventional Cardiologist and Interventional Echocardiographer is vital Both 3D echo (MPR/Flexi Slice) and fluoro allow for direct virtual control Imaging-guided control of the position and angulation of each anchor allow to control position and angulation of each anchor Cinching effect and gradients are controlled under normal hemodynamic conditions Procedure von Bardeleben, RS Mainz