1 / 12

Few Patients With Functional MR Are Treated Surgically: Duke Database Results

Few Patients With Functional MR Are Treated Surgically: Duke Database Results. Mitchell W. Krucoff MD FACC, FAHA, FSCAI Professor of Medicine / Cardiology Duke University Medical Center Director, Cardiovascular Devices Unit Duke Clinical Research Institute. Conflict of Interest.

saxon
Télécharger la présentation

Few Patients With Functional MR Are Treated Surgically: Duke Database Results

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Few Patients With Functional MR Are Treated Surgically:Duke Database Results Mitchell W. KrucoffMD FACC, FAHA, FSCAI Professor of Medicine / Cardiology Duke University Medical Center Director, Cardiovascular Devices Unit Duke Clinical Research Institute

  2. Conflict of Interest Research grants, consulting, advisory: • Abbott Vascular • Cardiac Dimension • Medtronic • St. Jude

  3. Acknowledgement ZainabSamad, Eric Yow, Linda K Shaw, Hussein R Al-Khalidi, Kristine Arges, John H Toptine, Andrew Wang, James G Jollis, Eric J Velazquez AHA 2011

  4. Background • While systematic “real world” data exist on patients with MR undergoing surgery (Society of Thoracic Surgery=STS database), there is far less information on the incidence and outcomes of MR patients managed medically. • While valve repair/replacement is accepted therapy for degenerative MR, the value of such interventions in functional MR patients is unknown

  5. Duke Cardiovascular Database (1995-2012) 126,796 Unique Patients Moderate or Severe MR Echo + Cardiac Catheterization N=30,848 Cath within 1 yr N=27,045 N=3,920 Cath outside 1 yr N=3,803 N= 280 Echo only N=74,367 N=5,109 Cardiac Catheterization only N=21,579 N= 242 9,551 (7.5%) with Moderate or Severe MR

  6. Treatments Received

  7. Unadjusted Survival by MR Severity* *censored at surgery

  8. Survival: Moderate or Severe MR by Treatment – Unadjusted* Survival Probability

  9. Results Echo and Cardiac Catheterization within 1 yr + Moderate or Severe MR N = 3920 • High Risk Criteria: • STS score ≥ 12% • Age > 75 + EF <40% • Functional MR + EF <40% • ≥ 2 prior chest surgeries • Prior chest surgery + EF <35% + Cr > 2.5 mg/dL • Age > 75 + prior chest surgery + Cr > 2.5 mg/dL • Hepatic cirrhosis • Dialysis • Chronic lung disease • Prior stroke • Prior CABG Non-High Risk N= 1666 High Risk N= 2254

  10. Survival: Moderate or Severe MR by Risk Group- Unadjusted*

  11. Survival: High Risk Moderate or Severe MR by Treatment

  12. Treatment of Severe FMR:Observations From Longitudinal Data • Valve surgery is rare in all FMR, mild, moderate, severe • Combined high risk and moderate/severe MR outcomes are poor with and without surgery • Longitudinal natural history models of FMR patients may be helpful in percutaneous MV study designs

More Related