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Update : November 14, 2008

	Left main coronary disease

	Ostial disease

	Bifurcation

	Graft vessel disease

	Diffuse coronary disease

	Chronic total occlusion (CTO)

	Restenosis

	Multivessel disease

	Drug eluting stent

	Vulnerable plaque

Euro PCR 2004

Untitled Document

Percutaneous valve interventions II

Dr Alec Vahanian (Bichat Hospital, Paris, France) said "Today we are just taking the very first steps of percutaneous valve repair and replacement. These first steps suggest that these new techniques are feasible. But if we try to pretend that we know how these will turn out later, it's only guesses and wishful thinking."

Some of the biggest names in percutaneous valve therapies presented new data and live demonstrations during the meeting, including Dr Alain Cribier (Charles Nicolle Hospital, Rouen, France), credited with being the driving force behind percutaneous valvular interventions. Cribier reported updates on 20 patients (16 of whom are part of the I-REVIVE trial), all of whom had end-stage aortic stenosis and life-threatening comorbidities and were treated on a compassionate-use basis with the Percutaneous Heart ValveTM. At up to eight months, 12 of the 20 patients had died, frequently due to comorbidities, but in all cases in which implantation was successfully performed patients experienced immediate improvement in hemodynamic and clinical criteria. Of the eight survivors, none had signs of valve dysfunction or heart failure.

New mitral-regurgitation approaches

On the mitral-valve front, Dr Peter C Block (Emory University, Atlanta, GA) presented an update from the EVEREST trial testing the EvalveTM E2E device, designed to emulate the surgical edge-to-edge mitral-valve repair procedure for mitral regurgitation. Expanding on data presented by Dr Ted Feldman (Evanston Hospital, IL) at the 2003 American College of Cardiology meeting, Dr Block noted that 15 patients have now been enrolled in the study, all of whom underwent successful coaptation and 12 of whom received the clip joining their anterior and posterior mitral-valve leaflets. In these patients, mitral regurgitation grade remained at 2+ or less at six months of follow-up, while NYHA class improved or remained unchanged.

Elsewhere, Dr Maurice Buchbinder (Foundation for Cardiovascular Medicine, La Jolla, CA) showed results from animal studies using the Edwards Lifesciences percutaneous mitral-valve repair device, which combines the edge-to-edge approach with a percutaneous mitral-valve annuloplasty. The animal results are promising, he said, and human studies are slated to begin in early 2005.

The percutaneous fix

The percutaneous valve repair will undoubtedly play a role in the future, Vahanian concluded, especially since "many patients are willing to have everything fixed percutaneously."

Indeed, he noted, as many as one third of all patients with severe valvular heart disease are not operated on because they are deemed too high risk for surgery. "We must find an option for the patients with serious comorbidities who today are not being sent for surgical interventions," he said.

"The recipe for us to follow is to carefully evaluate the results of our early efforts and to work in close collaboration with our friends, the surgeons, who know a lot about these conditions," Vahanian advised. Some of the big hurdles ahead will be coming up with appropriate trial designs and comparators, particularly if the target patient group is going to be expanded to patients who are eligible for surgery. "To me, this is the only way to ensure a long and happy life for this newborn in interventional cardiology," he concluded.