Interventional+Procedures

1. Interventional Procedures

2. Roadmap
•Valve Diseases
•PCI & CABG
•Cardiac Devices
•Cardiac Resynchronization Therapy
•Artificial Heart

3. VALVE DISEASES

4. Introduction
•Heart valve disease refers to several
conditions that prevent one or more of
the valves in the heart from opening and
closing properly.
•Heart valve disease can cause either a
leaky valve (regurgitation) or a valve
that does not open wide enough
(stenosis).
• Untreated heart valve disease can cause
symptoms and reduce a person's quality
of life and overall survival.

5. •When the heart’s valves become severely damaged, heart surgery is
used to repair or replace the valve.
•Most patients are able to undergo surgery without difficulty. 
•However, for people whose heart function is too severely
compromised to withstand surgery, several approaches to treat heart
valve disease without surgery have been developed.
•These approaches can be divided into three categories:
oClinical Practice – used in every day clinical practice
oInvestigational – current clinical studies are underway
oEarly Development –early stages of investigation

6. Percutaneous Aortic Valve Replacement –
An Investigational Approach
•Percutaneous aortic valve replacement (AVR) is a new treatment
being investigated for select patients with severe symptomatic
aortic stenosis (narrowing of the aortic valve opening).
•A stenotic valve prevents the flow of blood antegrade from the left
ventricle to the aorta, during systole.
•There is an increased rate of sudden death of patients with aortic
stenosis.
•Dyspnea (labored breathing), fatigue, and palpitations are late
symptoms of aortic insufficiency.
•Angina pectoris is associated with the latest stages of aortic
insufficiency.

7. Percutaneous Aortic Valve Replacement –
Initial Diagnosis
•By auscultation (listening) with a stethoscope.
•Additional procedures associated with diagnosis to
judge severity of the lesion include -
–chest x ray,
–Echocardiography
–angiography with cardiac catheterization.
–In the absence of angiography, magnetic resonance imaging
(MRI) or computed tomographic (CT) imaging may be used.

8. •The procedure is performed in the catheterization lab.
•During the procedure a catheter is placed through the femoral artery
(in the groin) and guided into the chambers of the heart. 
•A compressed tissue heart valve is placed on the balloon-mounted
catheter and is positioned directly over the diseased aortic valve. 
•Once in position, the balloon is inflated to secure the valve in place.
•For patients with severe peripheral vascular disease, surgeons  and
cardiologists are testing an alternative approach through the left
ventricular apex of the heart.
Percutaneous Aortic Valve Replacement –
Procedure

9. Balloon catheter with valve is
inserted in the diseased valve
Balloon is inflated to secure the valve
Valve is secured in place
Replaced Aortic Valve

10. Percutaneous Mitral Valve Repair
An Investigational Approach
•Clinical trial is currently being performed to determine
the effectiveness of a percutaneous approach for treating
mitral valve regurgitation.
•The procedure is performed in the cardiac catheterization
laboratory with the aid of echocardiography.

11. Percutaneous Mitral Valve Repair
Procedure
•A very small, specially made metal clip device is delivered through a
catheter inserted into the femoral vein (in the groin) and advanced to
the heart.
•Guided by echocardiography, the cardiologist attaches the clip to the
flaps of the mitral valve.
•Placement of the clip is adjusted until optimal improvement in blood
flow and pressures through the valve are observed.
•Then, the clip is released, and the catheter is withdrawn. The clip
holds the valve flaps in position, which limits the leakage.

12. Mitral Valve Clip
Percutaneous Valve Repair System
*Evalve, Inc.

13. •In some patients, mitral regurgitation could be treated percutaneously by
placement of a device in the coronary sinus via a catheter.  
•Placement of the prosthetic device pushes the support structures of the mitral
valve and its leaflets back into more normal alignment, mimicking a surgical
annuloplasty.
•The prosthesis is a metal bar, about 7 cm in usable length and 1.5 mm in
diameter, flexible at both ends and stiff in the middle.
•Guided by fluoroscopy and transesophageal echocardiography, the bar is
positioned within the coronary sinus, near the posterior valve annulus.
•By exerting pressure on the dilated annulus and pushing it and its attached
leaflet closer toward the other leaflet, the device helps restore more normal
valve alignment and hemodynamics. 

14. The catheter resides within
the coronary sinus
The prosthesis (shown within catheter)
straightens the natural curvature of the
vein and exerts pressure on the dilated
annulus, pushing it and its attached
leaflet forward to help restore more
normal valve leaflet alignment. 
*Evalve, Inc.

15. PCI & CABG

16. Percutaneous Coronary Intervention
Introduction
•Percutaneous coronary intervention (PCI), commonly known as
coronary angioplasty or simply angioplasty, is a therapeutic
procedure to treat the stenotic (narrowed) coronary arteries of the
heart found in coronary heart disease.
•These stenotic segments are due to the build up of cholesterol-
laden plaques that form due to atherosclerosis.
•Percutaneous coronary intervention can be performed to reduce
or eliminate the symptoms of coronary artery disease, including
angina (chest pain), dyspnea (shortness of breath) on exertion,
and congestive heart failure.
•PCI is also used to abort an acute myocardial infarction, and in
some specific cases it may reduce mortality.

18. Coronary Artery Bypass Graft
Introduction
•Coronary artery bypass surgery, also coronary artery bypass graft
surgery, and colloquially heart bypass or bypass surgery is a
surgical procedure performed to relieve angina and reduce the risk
of death from coronary artery disease.
•Arteries or veins from elsewhere in the patient's body are grafted to
the coronary arteries to bypass atherosclerotic narrowings and
improve the blood supply to the coronary circulation supplying the
myocardium (heart muscle).
•This surgery is usually performed with the heart stopped,
necessitating the usage of cardiopulmonary bypass; techniques are
available to perform CABG on a beating heart, so-called "off-pump"
surgery.

19. Conventional CABG
•Most common arteries
bypassed:
–Right coronary artery
–Left anterior descending coronary
artery
–Circumflex coronary artery
Adapted from BJ Harlan, et al; Manual of Cardiac Surgery

21. CARDIAC DEVICES

22. Implantable Cardioverter Defibrillator (ICD)
What is it?
•An implantable Cardioverter Defibrillator (ICD) is a
device that monitors heart rhythms, and delivers shocks
if dangerous rhythms are detected.
•Many ICDs record the heart’s electrical patterns
whenever an abnormal heart beat occurs.

23. •ICDs are used to treat patients:
– Whose lower heart chambers (ventricles) beat too quickly
(tachycardia) or quiver ineffectively (fibrillation).
–Also used in patients who are at risk of these conditions due to
previous cardiac arrest, heart failure, or ineffective drug therapy
for abnormal heart rhythms.
Implantable Cardioverter Defibrillator (ICD)
When is it used?

24. •Like a pacemaker, an ICD consists of a battery and electrical
circuitry (pulse generator) connected to one or more insulated
wires.
• The pulse generator and batteries are sealed together and
implanted under the skin, usually near the shoulder.
•The wires are threaded through blood vessels from the ICD to the
heart muscle.
•The ICD continuously checks the heart rate. When it detects a too-
rapid or irregular heartbeat, it delivers a shock that resets the heart
to a more normal rate and electrical pattern (cardioversion).
•Stopping the potentially fatal fibrillation is called defibrillation.
Implantable Cardioverter Defibrillator (ICD)
How does it work?

25. •An ICD detects a rapid heartbeat coming from the bottom of the heart
•ICDs protect against sudden cardiac death from ventricular tachycardia
and ventricular fibrillation

26. Implantable Cardioverter Defibrillator (ICD)
Types
Single chamber ICD
•Lead is attached in the right ventricle.
•If needed, energy is delivered to the
ventricle to help it contract normally.
Dual chamber ICD
•Leads are attached in the right atrium &
the right ventricle.
•Energy is delivered first to the right
atrium and then to the right ventricle,
helping your heart to beat in a normal
sequence

27. Implantable Cardioverter Defibrillator (ICD)
Types
Biventricular ICD
•Leads are attached in the right atrium, the right ventricle and
the left ventricle.
•This technique helps the heart beat in a more balanced way and
is specifically used for patients with heart failure.

28. CARDIAC RESYNCHRONIZATION
THERAPY

29. Cardiac Resynchronization Therapy
Introduction
•Cardiac resynchronization therapy (CRT) is used to treat the delay
in heart ventricle contractions that occur in some people with
advanced heart failure.
•Heart failure means the heart’s pumping power is weaker than
normal.
•A delay between the contraction of the right and left ventricles often
occurs with heart failure, so the walls of the left ventricle are unable
to contract at the same time.

30. Cardiac Resynchronization Therapy
Device
•The CRT pacing device (also called a biventricular pacemaker) is an
electronic, battery-powered device that is surgically implanted under the
skin.
•The device has 2 or 3 leads (wires) that are positioned in the heart to help
the heart beat in a more balanced way.
•The leads are implanted through a vein in the right atrium and right
ventricle and into the coronary sinus vein to pace the left ventricle.
•The CRT device (biventricular pacemaker) has 2 or 3 leads that are
positioned in the:
–Right atrium
–Right ventricle
–Left ventricle (via the coronary sinus vein)

31. Cardiac Resynchronization Therapy
How Does It Works?
•When your heart rate drops below
the set, the device generates (fires)
small electrical impulses that pass
through the leads to the heart muscle.
•These impulses make the lower
chambers (ventricles) of the heart
muscle contract, causing the right
and left ventricles to pump together.
•The end result is improved cardiac
function.

32. Cardiac Resynchronization Therapy
Benefits
•CRT improves symptoms of heart failure in about 50% of
patients who have been treated maximally with
medications but still have severe or moderately severe
heart failure symptoms.
•CRT improves survival, quality of life, heart function,
the ability to exercise, and helps decrease
hospitalizations in select patients with severe or
moderately severe heart failure.

33. CRT and ICD therapy
•Some patients with heart failure may benefit from a combination of
CRT and an implantable cardiac defibrillator (ICD).
•These devices combine biventricular pacing with anti-tachycardia
pacing and internal defibrillators to deliver treatment as needed.
•The CRT/ICD combination devices:
–Resynchronize the heartbeat
–Slow down an abnormal fast heart rhythm
–Prevent abnormally slow heart rhythms
–Record a history of the patient’s heart rate and rhythm

34. ARTIFICIAL HEART

35. Artificial Heart
Introduction
•An artificial heart is a mechanical device that is implanted into the
body to replace the biological heart.
•The term “artificial heart” has often inaccurately been used to
describe ventricular assist devices (VADs), which are pumps that
assist the heart but don’t replace it.
•An artificial heart is also distinct from a cardiopulmonary bypass
machine (CPB), which is an external device used to provide the
functions of both the heart and lungs.
•CPBs are only used for a few hours at a time, most commonly
during heart surgery.

36. FDA-Approved Artificial Hearts
•CardioWest™ temporary
Total Artificial Heart
–It is the world’s first and only
FDA-approved Total Artificial
Heart.
–Originally designed as a
permanent replacement heart, it
is currently approved as a bridge
to human heart transplant for
patients dying because both sides
of their hearts are failing
(irreversible end stage
biventricular failure).

37. •AbioCor® Replacement
Heart
–The AbioCor is approved for
use in severe biventricular
end stage heart disease
patients who are not eligible
for heart transplant and have
no other viable treatment
options.
FDA-Approved Artificial Hearts

38. THANK YOU