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398 Cardio Diabetes Medicine 2017

gery also.
PARTNER 3 And Corevalve Low risk Trial are eval-
uating TAVR vs Surgery in low risk patients. NO-
TION(5)”container-title”:”Journal of the American Col-
lege of Cardiology”,”page”:”2184”,”volume”:”65”,”is-
sue”:”20”,”abstract”:”Background Transcatheter
aortic valve replacement (TAVRTrial randomized 280
patients- Mean age was 79.1 years, and 81.8% were
considered low-risk patients, STS < 4%. In the inten-
tion-to-treat population, no significant difference in
the primary endpoint was found (13.1% vs. 16.3%; p =
0.43 for superiority)
In the near future, all patients with degenerative aor-
tic stenosis will undergo TAVR and not surgery.

Figure 5: Growth of TAVR vs Surgical AVR in the US
Transcatheter Mitral Valve Repair / Figure 6: Mitraclip for MV repair.
Replacement (TMVR)
Mitral valve repair devices that have received CE Mark
TMV repair has been slower to grow than TAVR due include the Abbott Mitraclip, Mitralign and Edwards
to the complexity of the mitral valve and its function Cardioband. Mitraclip was first implanted in 2003
in relation to the Left ventricle. Mitral valve regurgi- and has been used to most with worldwide use in >
tation can be primary or secondary.Primary etiology 45000 patients.
involves degeneration of the MV apparatus. Second-
ary etiology is due to LV dysfunction and annular dil- Currently in the US this is approved for Primary MR
atation. This makes treatment of mitral valve defects only however data is encouraging in patients with
more complex as there is no single solution that will secondary MR.
work for all the etiologies.
EVEREST II(6) randomized 279 patients with moder-
ate to severe (3+ or 4+) MR and high surgical risk in a
2:1 fashion to either percutaneous (n = 184) or surgical
(n = 95) treatment. The primary outcome was freedom
from a composite of death, repeat mitral surgery, or
3+ or 4+ MR. At 5 years, this occurred in 44.2% of
MitraClip patients vs 64.3% of surgical patients (P =
0.01). Mortality was not different between groups.
The composite outcome was driven by higher rates
of moderate-to-severe MR (12.3% vs 1.8%; P = 0.02)
and mitral surgery (27.9% vs 8.9%; P = 0.03) in the
percutaneous group. Looking at the data over time,
however, the majority (78%) of mitral surgeries oc-

GCDC 2017