Presentation is loading. Please wait.

Presentation is loading. Please wait.

20090417 Heart Failure With Preserved EFx: Corassist Mitchell W. Krucoff MD FACC, FAHA, FSCAI Professor of Medicine / Cardiology Duke University Medical.

Similar presentations


Presentation on theme: "20090417 Heart Failure With Preserved EFx: Corassist Mitchell W. Krucoff MD FACC, FAHA, FSCAI Professor of Medicine / Cardiology Duke University Medical."— Presentation transcript:

1 Heart Failure With Preserved EFx: Corassist Mitchell W. Krucoff MD FACC, FAHA, FSCAI Professor of Medicine / Cardiology Duke University Medical Center Director, Cardiovascular Devices Unit Duke Clinical Research Institute

2 Conflict of Interest Scientific Consultant, Corassist

3 Heart Failure Heart failure is the pathophysiological state in which the heart is unable to pump blood at a rate commensurate with the requirements of the metabolizing tissue or can do so only from an elevated filling pressure Diastolic Heart Failure (DHF/HFPEF) Inability of left ventricle (LV) to fill properly due to stiffening and/or impaired relaxation. Increased ventricular filling pressure leads to left atrial enlargement, atrial fibrillation, pulmonary congestion Systolic Heart Failure (SHF) Inability of left ventricle (LV) to contract properly due to myocardial damage leads to pulmonary and/or systemic edema 3 DHF SHF CHF Pathophysiology

4 Therapeutic Modalities for CHF SHF: n Medical: l Afterload l Preload l Diuretics l Inotropes n Revascularization n Mitral valve Rx n Devices: l ICD l CRT HFPEF/DHF: n Medical: l Negative inotropes n Surgical: l Myomectomy n Devices: l V-pacing

5 Year Trends in CHF: Rising Incidence & Morbidity of DHF 5 Owen& Redfield MM, New England J Med. 2006;355: Aging Hypertension Aortic stenosis HOCM Infiltrative

6 HFPEF: Animal Models ??

7 Porcine (Minipig): Renal Wrap LVH/DHF Model LV Mass Increase vs. Time Shofti R., Israel Institute of Technology, The Technion, Haifa

8 HFPEF: Surrogate Imaging ??

9 Echocardiographic surrogates: Speckle Tracking, Strain & Rotation n LV rotation (Rotation and reverse rotation) n LV diastolic strain and strain rate (SR E/S ratio) Norm al S E A Geyer H et al, JAmSoc Echocardiogr 2010;23: Takeuchi M et al European Heart Journal (2007) 28, 2756–2762 Carasso S J Am Soc Echocardiogr 2010;23: Carasso S et al J Am Soc Echocardiogr 2012

10 HFPEF: Corassist Technology

11 A Novel Device Construct for DHF: Systolic Spring-loading n “Passive” energy capture from systole n “Active” force for diastolic compliance & volume The Robin Hood Effect 2% systolic energy capture 50% increase diastolic energy delivery

12 HFPEF Device Platforms n ImCardia ® epicardial spring coils n CORolla ® endocardial spring *CorAssist Cardiovascular Ltd

13 ImCardia ® Device Features n External “pacemaker” screw anchors n Cross-screw epicardial springs n Standard LV postioning grid n Median sternotomy implantation * *Courtesy of Renu Virmani, CV Path

14 Progressive deterioration in endocardial strain rate in controls (blue). Device implantation reversed strain almost to pre-renal wrapping values (magenta). Day 0: baseline after which renal wrapping preformed. Yellow marks – post thoracotomy Upward Trend Downward Trend Graph 1: Endocardial peak dia/sys strain rate ratio – Device (n=3) Graph 2: Endocardial strain dia/sys rate ratio – Control (n=3) Porcine Renal Wrap DHF Model 36 Week Strain Results

15 Renal wrapping caused deterioration in early apical untwisting, with decreased LV suction (blue). Device implantation improved early apical untwisting almost to pre-renal wrapping values (magenta Graph 1: Decrease in apical early diastolic reverse rotation – Device (n=2) Graph 2: Decrease in apical early diastolic reverse rotation – Control (n=3) Upward Trend Downward Trend Porcine Renal Wrap DHF Model 36 Week Early Apical Untwisting Results

16 ImCardia First In Human n Single center n AS patients: l Clinically indicated AoVR l LVH/DHF by echo n N=10 unblinded implant patients n N=8 concomitant observational AoVR n Perioperative device tolerance demonstrated (safety) n 24 month follow up in 14/18 patients

17 ImCardia ® 24 month AoV Gradient & EFx 17 Aortic Peak Gradient Ejection Fraction

18 ImCardia ® 24 month LA Area, LV Mass 18 LA Area LV Mass

19 CORolla Technology Platform n Endocardial nitinol spring n Increased energy transfer efficiency n Trans-apical insertion (thoracotomy) n Retractable

20 Trans-Apical Sheep Deployment: Hadassah Ein-Kerem Animal Laboratories, Jerusalem 20

21 CORolla ® Pre Clinical – In Vivo Results 21 Results and conclusions to date: No procedure-related or device-related deaths Animal recuperation was quick No embolic events or endocardial erosion

22 Device Therapy for Diastolic HF (DHF): Conclusions n HF with preserved systolic function is a large and rapidly growing source of morbidity & health care costs n Surgical, medical and device therapies for DHF have limited therapeutic impact n Animal models of DHF are very limited n Systolic energy “loading” of metallic diastolic spring technology represents a novel device-based approach to DHF l FIM using surgically implanted epicardial springs in a human AS model appears safe and possibly effective l Trans-apical delivery of an intraventricular spring coil may augment both diastolic efficiency and ease of use

23 Heart Failure With Preserved EFx: Corassist Mitchell W. Krucoff MD FACC, FAHA, FSCAI Professor of Medicine / Cardiology Duke University Medical Center Director, Cardiovascular Devices Unit Duke Clinical Research Institute


Download ppt "20090417 Heart Failure With Preserved EFx: Corassist Mitchell W. Krucoff MD FACC, FAHA, FSCAI Professor of Medicine / Cardiology Duke University Medical."

Similar presentations


Ads by Google