Sapien3による二尖弁TAVI 二尖弁に対す …

1 Japan Transcatheter Valve Therapies 201838PD1-1 Sapien3 TAVI 1 1 1 1 1 1 1 1 2 2 2 2 11 2 PD1-2 CoreValve/Evolut R 1 2 1 1 3 3 1 1 3 11 2 3 (TAVI) Sapien3 outer skirt inter-commissural space CT (BAV)

2 BAV 2 1 88 Type1L-R 502mm2 inter-commissural space 26mm BAV23mm 23mm 2 49 Type0 Type1 CT inter-commissural space 2 commissure 22mm 20mm 23mm BAV20mm indentation 20mm BAV BAV AR BAV PCPS TAVI 26mm BAV underfill BAV skip CT direct TAVI 86 Type1L-R 506mm2 inter-commissural space 26mm underfill Nominal 1ml TAVI challenging TAVR CoreValve/Evolut R 2018 1 27 (SAPIEN series 7 CoreValve 9 Evolut R 11 ) CoreValve/Evolut R 20 ( (%) Type 0: 11 type 1.)

3 9 ) CoreValve/Evolut R Valsalva ( ) TAVR TF/iliac 19 DAo 1 45% 1 (PVL) mild 14 ( ) trivial 5 ( ) none 1 ( ) moderate Type 0 PVL trivial type 1( ) (post mPG mmHg post AVA cm2) (331 27-1097 ) MACE CoreValve/Evolut R TAVI Japan Transcatheter Valve Therapies 201839PD1-3 My best case and worst case: SAPIEN 3 PD1-4 2016 1 CoreValve VIV type-1 ?

4 ? EvolutR Sapien3 Round Type 0 EvolutR Type1 Sapien3 Worst case Best case Sapien3 Screening Sapien3 Screening 88 NYHA class: 2 SAVR STS PROM: TAVI TTE AVA: AVPG: 74mmHg AV : LVEF: 65% mild AR mild MR CT RCC/LCC type-1 LVOT : x aortic root angle: 62 horizontal aorta : LCC SOV : Edwards Sapien XT PVL 2016 1 Medtronic CoreValve 2 PTAV TEE EIA.

5 8mm 18Fr Cook Check-Flo 7Fr Rinato TAVI 18mm CoreValve26mm NCC 0-1mm pop-up VIV 2 CoreValve26mm 3-4mm VIV AV peak to peak: 96mmHg 18mm 19mmHg EIA EVT CoreValve/Evolut-R pop-up dive-in CoreValve CoreValve in CoreValve TAVI Japan Transcatheter Valve Therapies 201840PD2-1 MR MitraClip PD2-2 MitraClip

6 2018 4 MitraClip MitraClip 1. Brockenbrough 2. 3. 4. 5. 6. 7. second clip 8. 9. MR 80-100 MR MitraClip 2018 4 MR MitraClip MR MR NYHA Kansas City KCCQ MitraClip 30 MR3+ 13% MR2+ 30 30% 40% MR MitraClip

7 MR MitraClip 2 MitraClip memoJapan Transcatheter Valve Therapies 201841PD2-3 MitraClip - - PD2-4 MitraClip MitraClip severe MR mild Msr MR 2+ MR Mr Mr MR (CD) (color flor jet area) vena contracta width S E (ERO)

8 Volmetric CD MitraClip TEE PVF S PVF S PVF S S Mr S S S CD MR CD MR PVF S S MR 2018 4 MitraClip NT MitraClip MitraClip Clip 2nd Clip 3 1st Clip Clip 1st Clip 2nd Clip MR MR Clip double orifice MR MitraClip MitraClip Clip Clip Clip TEE MR

9 V MitraClip 2 MitraClip Japan Transcatheter Valve Therapies 201842PD3-1 My best case PD3-2 My worst case MitraClip MitraClip: My Best Case 80 ST NSTEMI TAVI 20% MR MR Logistic EuroSCORE 27% MitraClip Clip MR MitraClip MitraClip

10 30% MitraClip MitraClip Best Practice 82 NYHA II P III STS score MitraClip system 1 MitraClip I BNP III MitraClip 3 MitraClip My best case and worst caseJapan Transcatheter Valve Therapies 201843PD3-3 SLE TMVr 1,2 Gorav Ailawadi, MD2 Damien J.