jim is jim: live cases with no interruptions! i · jim 2017: continuous progress in complex...

Issue1Thursday

9 February 2017

The official newspaper of the Joint Interventional Meeting

JIM 2017: Continuous progress in complex coronary and structural interventions!

Picso Potential for STEMI patients

4

lamPoon technique takes on LVOT obstruction

Page 3

evolution in mitral valve repair

Page 4

one-year data for elastomeric EluNIR DES

Page 11

JIM is JIM: Live cases with no interruptions!

I n 2016 we inaugurated JIM in Mi-lan. The experience was positive and we decided to maintain the

location and the venue. The structure and the spirit of the Course will not change: live cases with practical tips and tricks and selected lectures covering the most important aspects of interventional cardiology.

This year we will discuss, and try to put into perspective, some shortcomings regarding bioresorb-able scaffolds. A half-day is devoted to progress in the field of bioresorb-able scaffolds, and our focus is on problems, with possible solutions highlighted, along with technological innovations. During live case trans-

missions, we demonstrate optimal implantation techniques in order to improve short- and long-term results.

Continuous emphasis will be maintained on current and new generation drug-eluting stents that are easily deliverable to most lesions, with very low thrombosis rates and solid long-term outcomes.

The strong partnership of JIM with CRF/TCT maintains the high scientific level that is needed. As always, the most relevant aspect, “The main theme of JIM”, will stay unchanged: “Uninterrupted live demonstrations.” Our goal is to be as close as possible to real life, with no cuts during live demonstra-

tions. Operators will demonstrate problem-solving techniques from the beginning to the end, and without

skipping any difficulties.Our philosophy is to communicate

Eberhard GrubeAntonio Colombo

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2 JIM today Issue 1 Thursday 9 February 2017

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JIM TodayPublishing and ProductionMediFore Limited

Course DirectorsAntonio Colombo, MD, Eberhard Grube, MDMartin B. Leon, MD, Carlo Di Mario, MDJeffrey W. Moses, MD, Gregg W. Stone, MD

Associate DirectorsAlexandre C. Abizaid, MD, Seung Jung Park, MD, Nicolas Van Mieghem, MD, Stephan Windecker, MD

Editor-in-ChiefPeter Stevenson

EditorRysarda Burmicz

DesignPeter Williams

Industry Liaison ManagerAmanda D’rojcas

Head OfficeMediFore Limited51 Fox Hill, London SE19 2XE, UKTelephone: +44 (0) 208 771 [email protected]

Copyright © 2017: Victory Project Congressi. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, transmitted in any form or by any other means, electronic, mechanical, photocopying, recording or otherwise without prior permission in writing of JIM. The content of JIM Today does not necessarily reflect the opinion of the JIM 2017 Course Directors or the JIM Organisational Committee.

ProgrammeThursday, February 9 2017

Main Hall Washington

8.00 Welcome and Opening Address Antonio Colombo and Eberhard Grube

Chairman: Martin B. LeonCo-chairman: Carlo Di Mario

8.05 LIVE CASES FROM BONN, GERMANYUniversity Hospital

Commentators: Ted Feldman, Oscar Mendiz, Ghada Mikhail, Bernhard Reimers, Nicolas Van Mieghem

Operators: Eberhard Grube, Georg Nickenig, Nikos Werner, Jan Malte Sinning, Armin Welz, Fritz Mellert, Wolfgang Schiller, Robert Schueler

Guest operators: Paul Hsien-Li Kao, Marco Wainstein

On-line factoids relevant to the cases presented: Lorenzo Azzalini (Coordinator), Giuliana Capretti, Satoru Mitomo, Damiano Regazzoli

09.45 DEBATE Is imaging during PCI so important?

Pro: Carlo Di MarioCon: Michael Haude

10.15 Coffee break

10.45 LIVE CASES FROM MILAN, ITALY

St. Raffaele HospitalCommentators: David Antoniucci, Francesco

Bedogni, Ted Feldman, Michael Haude, Hazem Khamis, Georgios Sianos

Operators: Antonio Colombo, Mauro Carlino, Alaide Chieffo, Francesco Giannini, Azeem Latib, Matteo Montorfano


Continued on page 4

what we perform everyday. The interventionist will address the sequential steps of each proce-dure with the hope to obtain an optimal clinical result in the most cost-effective manner. Such a combination should match safety with outcome, while giv-ing valuable teaching messages. The possibility to have experts willing to give their suggestions is an additional invaluable tool in

reaching the final objective.The Bonn team will dem-

onstrate the cutting edge of structural interventions, while the San Raffaele and Columbus teams will maintain the necessary balance with coronary interven-tions. On Friday afternoon, a live transmission from Columbia University/Presbyterian Hospital in New York will show the Ameri-can approach.

Furthermore, a section

devoted to “Selected Case Pres-entations” on Saturday morning will give a nice opportunity for various institutions around the world to share their experiences.

Our hope is that JIM 2017 will give each participant a con-tinuous learning experience to improve the care of our patients.

We thank all of you for your continuous support.Antonio Colombo, Eberhard Grube and all the CRF Team

JIM 2017: Continuous progress in complex coronary and structural interventions!

LIVE CASES @ JIM 2017We look forward to welcoming you in the comprehensive live case sessions at this year’s meeting. Take a seat in Main Hall Washington and watch as experts work, uninterrupted, on a range of challenging procedures!

Thursday08:05–09:45

BONN, GERMANYUniversity Hospital

10:45–12:30

MILAN, ITALYSt. Raffaele Hospital

14:30–16:30

BONN, GERMANY University Hospital

17:00–18:30


Friday08:00–10:00


10:30–12:30


14:30–15:45


16:45–18:15

NEW YORK, USAColumbia University NYP Hospital

Saturday08:30–09:30

MILAN, ITALYColumbus Hospital Heart Center

11:00–12:00

MILAN, ITALYColumbus Hospital Heart Center

Continued from page 1

Issue 1 Thursday 9 February 2017 JIM today 3

L eft ventricular outflow tract (LVOT) obstruc-tion is a potentially fatal complication of transcatheter mitral valve replacement

(TMVR), caused by septal displacement of the na-tive anterior mitral leaflet after valve deployment.1

With many traditional methods to resolve LVOT obstruction being sub-optimal, Adam B. Green-baum, Co-director of the Center for Structural Heart Disease at the Henry Ford Hospital, Detroit, MI, USA, will take to the stage today to introduce the LAMPOON technique, a closed chest, tran-scatheter Laceration of the Anterior Mitral leaflet to Prevent LVOT ObstructioN during TMVR.

Dr Greenbaum spoke to JIM Today to frame the current burden of LVOT obstruction, the LAMPOON technique itself, and the current and prospective data in its favour.

What are the underlying causes, risks and implications of LVOT following transcatheter mitral valve replacement?Significant LVOT obstruction during TMVR is a well-known and well-described complication of TMVR, yet its exact incidence is difficult to quantify.

While there have been case reports and small series reported in the literature, there is no defini-tive investigation. Additionally, we simply do not know the denominator of patients undergoing TMVR, nor does anyone know how many patients are being turned down for the procedure due to its risk. The risk does seem to vary between valve-in-valve, valve-in-ring and valve-in native MAC pro-cedures, with the lowest risk in those undergoing valve-in-valve procedures and the highest in those undergoing valve-in native MAC procedures.

Nonetheless, estimates based on personal ob-servation, communication with other large volume centres, as well as the national PI of the ongoing Mitral Trial and companies developing transcathe-

ter valves dedicated for the mitral position, suggest that up to one third of patients are at risk. Underly-ing causes include baseline anatomic variables such as LVOT diameter, the aorto-mitral angle as well as length and redundancy of the native anterior mitral leaflet, along with procedural variables including the size and depth of the transcatheter implant.

Which ‘traditional’ techniques have been used to circumvent/minimise LVOT (e.g. alcohol sep-tal ablation), and what are their limitations?The phenomenon of LVOT obstruction during MVR is well known to surgeons, and during surgical MVR the anterior leaflet is routinely removed or modified prior to valve insertion. To date, there have been few options to minimise the risk of LVOT obstruction during transcatheter MVR. Alcohol septal ablation has been used as a “bail-out” to acutely reduce septal wall motion and decrease wall thickness over time, increasing LVOT diameter in a few cases when life threatening obstruction occurred during TMVR. And, it has been used suc-cessfully in a “preparatory” manner in a handful of patients who were predicted to be of significant risk of life threatening LVOT obstruction during TMVR.

However, ETOH septal ablation carries certain risks and limitations. It requires a certain, not yet well-established septal thickness to avoid creation of a VSD, and it is uncertain how much alcohol is required given there is often no baseline obstruction. It requires 4-6 weeks to achieve ef-fect, often in sick patients simply not stable enough to delay the procedure, it requires a “candidate” septal perforator that is sometimes not present, and risks complete heart block requiring permanent pacing. Moreover, the increase in LVOT area gained by septal ablation can be variable, and may still not be sufficient in those predicted to be

at highest risk, i.e. those with the smaller predicted neo-LVOT areas.

Can you introduce LAMPOON, its basis and its two steps: leaflet traversal and leaflet lacera-tion?LAMPOON) was conceived as an attempt to modify the anterior leaflet prior to TMVR, mimick-ing surgical techniques. It involves transcatheter

electrosurgery-assisted laceration of the middle (A2) portion of the anterior leaflet from its base to free

tip, keeping the chordal structures intact, and using them to pull the leaflets to the sides – similar to “curtain stays.”

In this situation, the anterior leaflet no longer spans across the LVOT but rather lies on the septal and lateral sides of the transcatheter valve allowing blood to traverse the LVOT through the open struts of the implanted transcatheter valve. It involves two steps: “traversal”, in which the base of the anterior leaflet is punctured from LV to LA, and “laceration”, in which the leaflet is lacerated from the base to the free edge. Both steps are facilitated by electrification of a 0.014” guidewire

I believe to date the technique has been tested in animal studies. Can you give us a snapshot of the data?The procedure was developed at the National Institutes of Health (NIH) by Doctors Jaffar Khan and Robert Lederman in a joint project with Dr Vasilis Babaliaros at Emory University, and me at Henry Ford Hospital. Results from eight swine were published in JACC: Cardiovascular Interventions in late 2016,1 and results from the first five clinical patients performed at Emory and Henry Ford is cur-rently in press in the same journal.2 In all five clini-cal cases, LAMPOON was successful, and severe life-threatening LVOT obstruction was prevented. There were no complications related to LAMPOON.

TAVI 1 Foscolo Thursday 12:45–14:15

Novel LAMPOON technique takes on LVOT obstruction

“LAMPOON was conceived as an attempt to modify the anterior leaflet prior to TMVR, mimicking surgical techniques.”

Adam B. Greenbaum

Continued on page 4

Three-chamber and LVOT views with and without LAMPOON

The LAMPOON procedure


T his evening, Ted Feldman (NorthShore University HealthSystem , Evanston,

IL, USA) joins others to discuss the latest on the MitraClip system (Abbott, USA) in transcatheter mitral valve repair (TMVR) – the percutaneous edge-to-edge procedure to reduce mitral regurgita-tion by approximating the mitral valve leaflets, in a method derived from the surgical technique developed by Alfieri et al.1

Dr Feldman was interventional principle investiga-tor of EVEREST II (Endovascular Valve Edge-to-Edge Repair Study) the randomised controlled multi-centre study comparing the Mitra-Clip with mitral valve surgery for the treatment of grade 3+ or 4+

mitral valve regurgitation.2 The investigators published five-year results at the end of 2015, finding that patients treated percutane-ously more commonly required surgery for residual mitral regur-gitation primarily during the first

year after treatment. However, between one- and five-years of follow-up, rates of surgery and survival were comparable between groups.3

In an article commenting on the implications of EVEREST II,

Anyanwu and Adams (2015) highlighted the uniqueness of TMVR challenges and its study, setting it apart from those of transcatheter aortic valve repair. The pair had several criticisms of EVEREST II, namely: study popula-

tions should not be heterogeneous; inclu-sion criteria should mir-ror current guidelines and practice; high-quality repair centres only should participate, with a focus on patient compliance; young and low-risk patients

should be excluded; endpoints should be clinically relevant; and lastly inclusion criteria should mandate planned surgical repair of the valve.4

It was recognised that many patients with severe symptomatic

MitraClip NT Manzoni Thursday 18:45–19:45

Evolution continues in mitral valve repair

For whom might LAMPOON be particularly ap-plicable? Patients at higher risk of LVOT?We believe LAMPOON may be of particular benefit for any patient being evalu-ated for TMVR with significant risk of life-threatening LVOT obstruction, and this will be prospectively tested in a soon to start, FDA-approved, inves-tigator-initiated, multicentre IDE study. We do not feel that it should be reserved for only those felt to not be ideal for ETOH septal ablation, as septal ablation is equally untested, cannot always be successfully accomplished, requires an obligatory 4-6 week delay, and may carry higher risk in those without significant septal thickness.

Moreover, life threatening LVOT obstruction post TMVR can also occur even in those with adequate LVOT area, due to long anterior leaflet lengths and/or anterior leaflet redundancy causing mechanical interference with the transcatheter heart valve func-tion. This has also been successfully prevented with LAMPOON, but cannot be with septal ablation, which has no effect on the leaflet anatomy itself.

What limitations are important to emphasise?To date, there does not appear to be many ana-tomic contraindications to LAMPOON as it has successfully been performed even through heavily

calcified anterior leaflets, but it is performed retrograde through the aortic valve, so has yet to be performed in patients with mechanical aor-tic bioprostheses.

It should be noted that LAMPOON adds an ad-ditional level of complexity to an already somewhat compli-cated procedure, and may be best reserved for those with significant experience with

TMVR, as well as in the principles and application of transcatheter electrosurgery.References

1. Khan J M, etc. Intentional Laceration of the Anterior Mitral Valve Leaflet to Prevent Left Ventricular Outflow tract ObstructioN (LAMPOON) during Transcatheter Mitral Valve Implantation: Pre-clinical Findings. JACC: Cardiovascular Interventions, 2016; 9(17)

2. Babaliaros VC, Greenbaum AB, Khan JM, Rogers T, Wang DD, Eng MH, O’Neill WW, Paone G, Thourani VH, Lerakis S, Kim DW, Chen MY, Lederman RJ. Closed-chest laceration of the anterior mitral leaflet to prevent outflow obstruction (LAMPOON) during percutaneous TMVR: first-in-human experience. J Am Coll Cardiol Intv 2017 (in press)

TAVI 1 Foscolo Thursday 12:45–14:1512.45 Lunch Symposia

DESRoom Manzoni

Chairmen: Lutz Buellesfeld, Ron Waksman12.45 The COMBO Plus Dual Therapy Stent:

clinical update and experience Gennaro Sardella

13.00 Complex cases management with Onyx: the procedural benefit of the dedicated stent for small and large vessel Carlo Di Mario

13.15 Ultimaster DES: evidence for every clinical scenario Marco Valgimigli

13.30 The EluNIR clinical program: BIONICS and NIREUS - One-year follow-up Giuseppe Musumeci

13.40 EluNIR: the first elastomeric drug eluting stent Alaide Chieffo

Questions & Answers

TAVI 1Room Foscolo

Chairmen: Marco Barbanti, Hendrik Treede12.45 My evolving clinical experience: from Lotus

to Edge Giuseppe Tarantini13.05 Evolution of TAVI: transfemoral outcomes

using ACURATE neo Corrado Tamburino13.25 How about SAPIEN 3: transformational

change for intermediate-risk patients Martin B. Leon

13.45 LAMPOON. A novel technique to avoid LVOT obstruction during transcatheter mitral valve replacement (video) Adam Greenbaum

Questions & Answers

LAA Closure and TricuspidRoom Porta

Chairmen: Sergio Berti, Joachim Schofer12.45 Cardioband TR - Another gold standard

through a catheter Stephan von Bardeleben

13.05 4Tech present and future perspective Paolo Denti

13.25 Tricuspid Repair with Trialign Azeem Latib13.45 Clinical experience with LAmbre LAA

closure system Horst Sievert

Questions & Answers

CORONARY IMAGING TO GUIDE CORONARY INTERVENTIONSRoom Parini

Chairmen: Augusto Pichard, Francesco Prati12.45 Is stent malapposition a real issue?

Francesco Prati13.00 Old and new BVS. Is IVUS-OCT guidance a

must? Augusto Pichard13.15 I use FFR to make my procedures less

complex Michael Haude13.30 I use OCT to make my procedures less

complex Enrico Romagnoli13.45 What’s the clinical role of IVUS-NIRS?

Carlo Di Mario

Questions & Answers

CTORoom Club

Chairmen: Mauro Carlino, Jeffrey W. Moses12.45 Hemodynamic support for complete

revascularization in the CTO setting Jonathan Hill

13.00 My top tools for CTO PCI Roberto Garbo13.15 CTO and multi vessel disease. The key to

complete revascularization Simon Walsh


Continued on page 6

Novel LAMPOON technique takes on LVOT obstructionContinued from page 3

“[LAMPOON] will be prospectively tested in a soon to start, FDA-approved, investigator-initiated, multicentre IDE study.”

Adam B. Greenbaum

“[COAPT and Mitra-FR] will be critical in seeing the direction of use of many of our mitral therapies going forward.”

Ted Feldman


mitral regurgitation were at high risk for surgery, and this led to the EVER-EST High Risk Registry5, and ultimately to the main pattern of use of the MitraClip repair approach. Many registries have validated a good safety profile and consistent improvement in symptoms and clinical status in this high risk cohort. MitraClip obtained CE Mark approval in 2008.

On the basis of the EVEREST High Risk Registry results and other studies, in 2013 the US FDA approved the MitraClip for use in high-surgical risk patients. This widened the application to percutaneous reduction of signifi-cant symptomatic mitral regurgitation (MR ≥ 3+) due to primary abnormality of the mitral apparatus (degenerative MR) in those patients deemed at a prohibitively-high risk by a heart team – a cardiac surgeon experienced in mitral valve surgery and a cardiologist experienced in mitral valve disease – and in whom existing comorbidities would not preclude the expected benefit from reduction of the mitral regurgitation.

The session today will explore the current state of data on the Mitra-

Clip in TMVR, with a look forward to new frontiers with the MitraClip NT, as well as an exploration of new trial data on the horizon to clarify the position of MitraClip alongside other treatment strategies.

“We are looking forward as this whole field and a variety of technolo-gies develop,” Dr Feldman told JIM Today ahead of the meeting. “We are more concerned with looking forward, because we are at the begin-ning of the catheter journey for mitral valve disease. That said, the only device that we have a large experi-ence with, and an important database to support it, is the MitraClip.

“The therapy has been first remarkably safe and second highly successful in selected patients,” he continued. “And in the population for whom it is suitable, clinically and anatomically we see really gratifying improvements in symptoms and also in left ventricular function.”

Dr Feldman will be discussing two trials, COAPT (Cardiovascu-lar Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional

Mitral Regurgitation6) and Mitra-FR (Multicentre Study of Percutaneous Mitral Valve Repair MitraClip Device in Patients With Severe Secondary Mitral Regurgitation7), both of which aim to address the as-yet unanswered question of how MitraClip compares to standard medical therapy for functional mitral regurgitation. This is pertinent, explained Dr Feldman, especially because medicines for heart failure are “well-proven, and have a good track record.”

These two studies are in progress, he noted: “The trial populations are very specific and are heart failure patients with mitral regurgitation. COAPT has now randomised a little over 500 of its 610 intended patients. Mitra-FR has just completed enrolment; this is a 288-patient randomised comparison of medical therapy and MitraClip, and enrolment finished in January with over 290 patients treated.”

The purpose of these studies is to

define whether there is a real benefit of MitraClip compared to medical therapy with respect to safety and clinical efficacy of the MitraClip for severe functional mitral regurgitation in the heart failure patient popula-tion. This fundamental comparison between medical treatment and any procedure for mitral regurgitation has never previously been answered.

Asked what the possibility might be of sub-group analyses within either COAPT or Mitra-FR, Dr Feldman said: “There is always a lot of interest in sub-groups. The Mitra-FR trial, with a total trial population of under 300, may be difficult for sub-group analysis. The COAPT trial, with over 600 patients, is more likely to have the potential for sub-group analysis. There are some important subgroups, in particular patients who have al-ready failed cardiac resynchronisation pacing therapy.”

Interestingly, a subset of COAPT’s patients will be registered in a cardiopulmonary exercise sub-study, with the aim of evaluating the effect of MitraClip versus standard medical therapy on exercise response.6

COAPT commenced in 2012, with an estimated completion date of March 2021. Mitra-FR’s one-year follow-up is expected to emerge be-fore this, in mid-2018, noted Dr Feld-man. “We are all very anxious to see the results of these two trials, which will be critical in seeing the direction of use of many of our mitral therapies going forward.”

Dr Feldman speaks during this even-ing’s session, ‘MitraClip NT: Evolution in transcatheter mitral valve repair’ taking place in Room Manzoni be-tween 18:45 and 19:45.

References1. Alfieri O et al. The double-orifice technique in

mitral valve repair: a simple solution for com-plex problems. J Thorac Cardiovasc Surg 2001; 122:674–681.

2. Pivotal Study of a Percutaneous Mitral Valve Repair System (EVERESTIIRCT). Retrieved from https://clinicaltrials.gov/show/NCT00209274 (February 2017).

3. Feldman T et al. Randomized Comparison of Percutaneous Repair and Surgery for Mitral Regurgitation : 5-Year Results of EVEREST II. JACC 2015; 66(25): 2844-54.

4. Anyanwu AC and Adams DH. Evaluating Catheter-Based Mitral Valve Therapies : Lessons Learned and Future Directions. JACC 2015; 66(25):2855-9.

5. EVEREST II Pivotal Study High Risk Registry (HRR) (HRR). Retrieved from https://clinicaltrials.gov/ct2/show/NCT01940120 (February 2017).

6. Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regur-gitation (The COAPT Trial) (COAPT). Retrieved from https://clinicaltrials.gov/ct2/show/NCT01626079 (February 2017).

7. Multicentre Study of Percutaneous Mitral Valve Repair MitraClip Device in Patients With Severe Secondary Mitral Regurgitation (MITRA-FR). Retrieved from https://clinicaltrials.gov/ct2/show/NCT01920698 (February 2017).

MitraClip NT: Evolution in transcatheter mitral valve repair Manzoni Thursday 18:45–19:45

“We are at the beginning of the catheter journey for mitral valve disease.”

Ted Feldman


C linical experience with the LAmbre left atrial appendage (LAA) closure system (Lifetech Scientific Corp., China) will be

unveiled today at JIM, presented by Horst Sievert (CardioVascular Center (CVC) Frankfurt, Germany), a leading figure in LAA closure ever since he per-formed the first ever percutaneous closure in 2001.1

“The LAmbre device has a double membrane design which facilitates complete closure of the LAA,” Professor Sievert began in conversation with JIM Today. With a nitinol-based, self-expanding structure, the system has both a hook-embedded umbrella, and a cover connected with a short cen-tral waist, which allows LAmbre to articulate, and self-orient to the cardiac wall.2

As Professor Sievert went on to describe, the device has a number of unique features. Crucially, in contrast to several other devices, it is completely retrievable and repositionable. In addition, it has the smallest delivery sheath of all currently-available LAA closure devices.

“Really unique is its anchoring mechanism, which makes device embolisation almost impos-sible,” continued Professor Sievert. “And it is the only device which also comes in configurations and sizes specifically made for multi-lobed LAAs.

During deployment, the sheath does not have to be introduced deeply into the LAA, which may offer a treatment option for selected patients with LAA thrombus.”

As Professor Sievert described, the device received a CE mark in 2016, following a dedicated CE-mark study in which all 60 attempts of LAA closure with the LAmbre occluder were technically successful. Touching upon some specifics, he con-tinued: “Two pericardial effusions occurred, which is comparable to other devices, and at follow-up one patient experienced TIA after 6 months of LAA occlusion (1.6%), and one patient a Mallory-Weiss bleeding under dual platelet therapy (1.6%).

“In TEE, LAA closure (residual jet flow of < 5 mm) was achieved in 94.4% (51/54) and 91.7% (33/36) of patients at 6 and 12 months of LAA oc-clusion, respectively. None of the patients undergo-ing TEE revealed a thrombus on the device.”

Currently the device is available in a limited release, with new centres being able to participate. A post-marketing study is also planned.

Professor Sievert offered some take-home messages, commenting: “LAA closure has been available in clinical practice for many years. We have learned a lot about the implantation technique, which in turn has made the procedure much more safe.

“New devices have been developed which will make the procedure even more safe and effective. The LAmbre device is one of these new systems, with several major advantages.”References

1. Sievert H, et al. Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrilla-tion: early clinical experience. Circulation, 2002;105:1887–1889.

2. Lam Y-Y. A new left atrial appendage occluder (Lifetech LAmbreTM Device) for stroke prevention in atrial fibrillation. Cardiovascular Revascularization Medicine, 2013;14:134–136.

LAA closure and tricuspid Porta Thursday 12:45–14:15

LAmbre merges unique features under one umbrella

“The LAmbre device has a double membrane design which facilitates complete closure of the LAA.”

Horst Sievert

13.30 Minimize the approach for CTO case Andrea Gagnor

13.45 An overview about dedicated CTO wires Georgios Sianos

Questions & Answers

MAIN HALL WASHINGTON

Chairman: Gregg W. StoneCo-chairman: Alexandre Abizaid

14.30 LIVE CASES FROM BONN, GERMANYUniversity Hospital

Commentators: Antonio Bartorelli, Lutz Buellesfeld, Ghada Mikhail, Joachim Schofer, Goran Stankovic

Operators: Eberhard Grube, Georg Nickening, Nikos Werner, Jan Malte Sinning, Armin Welz, Fritz Mellert, Wolfang Schiller, Robert Schueler

Guest operators: Paul Hsien-Li Kao, Marco Wainstein


16.30 Coffee break

17.00 LIVE CASES FROM MILAN, ITALYSt. Raffaele Hospital

Commentators: Yaron Almagor, John Binoy, Carlo Briguori, Jeffrey W. Moses, Corrado Tamburino

Operators: Antonio Colombo, Mauro Carlino, Alaide Chieffo, Francesco Giannini, Azeem Latib, Matteo Montorfano


18.45 Evening SymposiumRoom Manzoni

Mitralclip NT: Evolution in transcatheter mitral valve repair

Chairmen: Antonio Colombo, Gennaro Sardella18.45 Overview in TMVR and our experience with

MitraClip Ted Feldman18.55 MitraClip NT: can we go over? What’s new

with MitraClip NT in procedure and patient selection? Carmelo Grasso

19.05 New frontiers with MitraClip NT and Econavigator Eustachio Agricola

19.15 Our experience in two cases of MitraClip NT in DMR and FMR patients Ciro Indolfi

Questions & Answers Wrap up Antonio Colombo,

Gennaro Sardella

A cocktail will be offered at the end of the Symposium



T omorrow sees a session dedicated to optimal acute and long term antithrombotic

therapy in PCI patients. Dominick J Angiolillo (University of Florida Col-lege of Medicine-Jacksonville, USA) speaks on the intravenous P2Y12 re-ceptor inhibitors, which he discussed with JIM Today ahead of the meeting.

Dr Angiolillo began by describ-ing the issues that have abounded in recent years regarding the use of oral P2Y12 inhibitors in the PCI pre-treatment setting: “The controversy surrounding whether or not patients should be (or should not be) pre-treated with a P2Y12 receptor inhibi-tor are largely derived by concerns for those patients who get pre-treated and, after defining coronary anatomy, are deemed to be candi-dates requiring surgical revascularisation.”

Patients who undergo bypass surgery while on dual antiplatelet therapy have a higher risk of bleeding complications, he explained. This means that, in most practices, patients need to undergo a 5- to 7-day washout to allow for the antiplatelet effect to be eliminated and to reintroduce a new pool of uninhibited platelets. “This time delay represents an inconvenience for the patient and the hospital (as it keeps a bed occupied),” he added, “And ultimately it leads to increased costs.”

He went on to describe settings in which patients may get pre-treated and ultimately not be shown to have coronary artery disease: “These patients, therefore, are inevitably ex-posed to a bleeding risk for no reason.

“Ultimately, clinical trial data have not been conclusive on the benefits of pre-treatment versus no pre-treat-ment with certain agents (clopidogrel

and ticagrelor) – as also endorsed by ESC practice guidelines, who now do not advocate one strategy versus another on this premise. [Meanwhile] other therapies (i.e. prasugrel) are clearly associated with harm, and thus not recommended unless the coro-nary anatomy has been defined.

“Overall, the need to pre-treat-ment largely depends on practice pat-terns. If time from clinical presentation is rather quick (a few hours, the same day) perhaps there is limited benefit of pre-treating. However, if a patient with an acute coronary syndrome will

take longer time to get to the cath lab, providing additional antithrom-botic coverage (other than aspirin and heparin) should be considered.”

Asked why the advent of cangre-lor is so significant, he explained that it represents a new treatment alternative for patients who have not been pre-treated. “Cangrelor is an intravenous P2Y12 receptor inhibitor with a very rapid onset (it exerts its effects within a few minutes compared with a few hours with the oral agents) and offset (returning to baseline function within 30-60 minutes versus several days with the oral agents) of action. Therefore, it is very convenient for pa-tients in acute settings, in particular undergoing PCI.”

Evidence to date regarding the

safety and efficacy of cangrelor for patients undergoing PCI (in fact leading to its clinical approval) derive from the CHAMPION PHOENIX trial, which showed that in P2Y12 receptor inhibitor naïve patients undergoing PCI across the spectrum of clinical presentations (stable CAD, NSTEMI and STEMI), cangrelor significantly reduced ischemic events – mainly myocardial infarction and stent thrombosis – relative to clopidogrel. Cangrelor was associated with an overall favourable safety profile.

Cangrelor has also been tested in other clinical settings, noted Dr Angiolillo – for example, as a bridg-ing strategy for patients requiring bypass surgery. He added: “It is also being used as a bridging strategy for patients undergoing non-cardiac surgery. To this extent, there is a dedi-cated dosing regimen. However, the use of cangrelor as a bridging drug is not an approved indication, although it is being used in clinical practice.”

Dr Angiolillo will speak in further detail during the session, ‘Clinical crossroads on optimal acute and long term antithrombotic therapy in patients treated with PCI’, taking place between 12.45 and 14.15 tomorrow in Room Foscolo.

Reference

1. A Clinical Trial Comparing Cangrelor to

Clopidogrel Standard Therapy in Subjects Who

Require Percutaneous Coronary Intervention

(PCI) (CHAMPION PHOENIX) (CHAMPION).

Retrieved from https://clinicaltrials.gov/ct2/

show/NCT01156571 (February 2017)

Clinical crossroads on optimal acute and long term antithrombotic therapy… Foscolo Friday 12:45–14:15

Right on time: intravenous P2Y12 receptor inhibitors

“Clinical trial data have not been conclusive on the benefits of pre-treatment versus no pre-treatment with certain agents (clopidogrel and ticagrelor).”

Dominick J Angiolillo

“Overall, the need to pre-treatment largely depends on practice patterns.”

Dominick J Angiolillo


A djunctive technologies for the treatment of various disease states will be exhibited this afternoon, including an overview of the

coronary sinus Reducer from Neovasc Inc. (Canada) – a novel percutaneous device for the treatment of refractory angina.1

Chronic refractory angina is a disabling condi-tion that is prevalent in an increasing number of people, largely due to a growing population of older patients living with coronary artery disease (CAD).2 With these sufferers often deemed as hav-ing ‘no option’, the condition represents a major clinical challenge in contemporary cardiovascular medicine. Patients with chronic refractory angina are often excluded from revascularisation for a number of reasons, such as unsuitable coronary anatomy, comorbidities, advanced age and micro-vascular dysfunction.2

Remarking on the therapies used to combat refractory angina, Francesco Giannini (San Raffaele Hospital & EMO-GVM Centro Cuore Columbus, Milan, Italy) commented: “In the last three dec-ades, a considerable number of innovative phar-macological and non-pharmacological therapeutic options have been investigated. However, not one of them has become a standard of care, nor has been routinely used in our clinical practice.

“Indeed, despite their initial promise, placebo-controlled trials have shown only modest improve-ments in exercise treadmill time and symptoms of

angina, and often they are not free from complica-tions. A proof of this is the weak recommendation that all non-pharmacological options have received in the 2013 European guidelines for the manage-ment of stable CAD.

“The only exception to this is probably the effect of ranolazine. Through inhibition of the late sodium current, it has been shown in several studies to result in an improvement in anginal symptoms and exercise tolerance. However, even with ranolazine treatment many patients still have angina symptoms. Thus it is not easy to say why

Adjunctive technologies Club Friday 12:45–14:15

The coronary sinus Reducer: A device-based therapy for refractory angina

“The coronary sinus Reducer was developed based on the principle of the Beck procedure. It consists of a balloon-expandable scaffold that is delivered percutaneously, and focally reduces the diameter of the coronary sinus to approximately 3 mm.”

Francesco Giannini

Continued on page 10

DON’T MISS!...Pay a visit to the wine corner at JIM for a refreshing chance to try delicious wines from the Colombo vineyard!


current pharmacological and non-pharmacological treatments have failed.”

Leading onto the rationale for the coronary sinus Reducer, Dr Giannini gave a potted history of coronary interventions through the veins, stating: “Almost 60 years ago, the cardiac surgeon Claude Beck proposed the surgical par-tial ligation of the coronary sinus (to achieve a 3 mm residual lumen diameter) in patients with severe coronary artery disease, showing in a comparative study a significant improvement in symptoms and reduced five-year mortality rate. It is important to note that this study was performed prior to the develop-ment of cardiopulmonary bypass, percutaneous coronary intervention and modern pharmacological therapies. Indeed, enthusiasm for the procedure was lost due to the widespread adoption of cardiac bypass surgery.

“The coronary sinus Reducer was developed based on the principle of the Beck procedure. It consists of a balloon-expandable scaffold that is delivered percutaneously, and focally reduces the diameter of the coronary sinus to approximately 3 mm. Ten years ago, the first-in-man study showed the safety of the device, and recently a randomised double-blind placebo controlled trial confirmed efficacy by improving anginal symptoms.”

As Dr Giannini described, following on from the encouraging data in the first human studies, the randomised, double-blinded COSIRA trial (Coronary Sinus Reducer for Treatment of Refractory Angina) was initiated.3 “The trial was rigorously designed

and randomised with 104 patients with refrac-tory angina (CCS III to IV angina) to coronary sinus Reducer implantations versus sham procedure. Of the patients in the treatment group, 35% had an improvement in at least two CCS classes when compared to 15% in the control group (p = 0.02). The Reducer implantation procedure was also as-

sociated with improvement of quality of life (evalu-ated by Seattle Angina Questionnaire) compared to placebo. When assessing ischaemia objectively, there was a trend toward improvement but this did not reach statistical significance.”

During his presentation at JIM 2017, Dr Gian-nini will share real-world experience with the Re-ducer, confirming its safety and efficacy in 46 pa-tients. As he underlined, Dr Giannini’s experience is the first to explore changes in myocardial perfusion after Reducer implantation using rest-stress Cardiac Magnetic Resonance and the myocardial Perfusion Reserve Index – a semi-quantitative method shown to be highly reproducible, sensitive and specific in detecting changes in myocardial ischaemia.

“The increase in myocardial perfusion observed in the ischaemic segments of the myocardium, albeit in a small number of patients (n=15), shows that the Reducer is able – as previously speculated

– to redistribute blood flow to the ischaemic ter-ritories. This finding, if confirmed in larger samples of patients – and especially if correlated to the degree of clinical response – might unequivocally demonstrate the efficacy of this novel device.”

Commenting on the limitations of Reducer treatment thus far, Dr Giannini added that from the

available data, approximately 20-25% of patients do not see a benefit. As he noted, this absence of sympto-matic improvement may be explained by unfavourable coronary venous anatomy: “Ubiquitous presence of thebesian veins, draining directly into the ventricular chambers, may pre-vent coronary venous pressure from rising despite adequate narrowing of the coronary sinus. But we need

evidence of that,” he said.Concluding with remarks on the future of the

device, Dr Giannini highlighted the upcoming FDA-approval trial in the US, as well as emphasising that larger randomised trials with longer follow-up are needed to confirm the Reducer’s efficacy, to evaluate how it exerts its action, and whether it objectively improves myocardial ischaemia.

“Moreover, further research is needed to under-stand why 20–30% of patients are nonresponders as shown by the first clinical studies and its effec-tiveness over the time,” he concluded.References

1. http://www.neovasc.com/wp-content/uploads/2013/11/COSIRA-Topline-Results-Press-Release.pdf

2. Giannini F, et al. The coronary sinus reducer: clinical evidence and technical aspects. Expert Review of Cardiovascular Therapy, 2017;15(1):47–58.

3. Verheye S, et al. Efficacy of a Device to Narrow the Coronary Sinus in Refractory Angina. N Engl J Med, 2015;372:519-527.



“The increase in myocardial perfusion observed in the ischaemic segments of the myocardium, albeit in a small number of patients (n=15), shows that the Reducer is able [to] redistribute blood flow to the ischaemic territories.”

Francesco Giannini

The coronary sinus Reducer: A device-based therapy for refractory angina


D uring a session dedicated to drug-eluting stents (DES), held this afternoon in Room

Manzoni, the first elastomeric DES, EluNIR (Medinol, Israel), will receive special focus, with invited experts joining together to discuss its unique design, trial data and beyond.

The EluNIR DES combines the established NIRxcell stent platform with a novel elastomer coating and ridaforolimus drug.1 “Medinol devel-oped the eDES™ (elastomer drug-eluting stent) coating in response to concerns over stents coated with durable and biodegradable polymers that are inherently brittle,” Giuseppe Musumeci (Ospedale Santa Croce e Carle, Cuneo, Italy) told JIM Today.

Indeed, the brittle nature of some traditional DES designs is a critical limitation, especially considering the extreme me-chanical and chemical strains a stent undergoes, with crimp-ing, tracking, expansion and drug-elution itself all putting the device under stress.

“EluNIR is coated with an elastomer that maintains a smooth and uniform surface designed to prevent the pro-inflammatory cracking or peeling that may occur with brittle polymers,” continued Dr Musumeci. “Furthermore, Medinol manufactures and coats the stent in flat panels, utilising its patented QualitySurface™ technol-ogy, ensuring quality, consistency and control over the coating and elution characteristics.”

Weighing in to comment on the EluNIR coating, Alaide Chieffo (San Raffaele Scientific Institute, Milan, Italy) noted that the benefits of the surface design can be clearly seen under high-resolution scanning electron microscopy (Figure 1): “El-uNIR’s coating appears to maintain

its integrity, in contrast to the visible degradation in coating of other stents,” she said.

“With the elastomeric coating, El-uNIR might offer clinical advantages such as better endothelialisation and lower rates of inflammation, stent thrombosis and restenosis. Further-more, the EluNIR stent uses struts at variable widths, which contributes to the stent’s conformability to the natural vessel curvature, reduces tissue prolapse, and theoretically

can be associated with apposition improvement.”

As Dr Chieffo described, EluNIR builds on the clinically-proven NIRxcell stent platform – a conform-able and uniform scaffolding that is mounted on a delivery system that has a distinctive spring top, thus offering improved deliverability (Figures 2A and B). “The successful clinical outcomes of the [NIRxcell] bare metal stent platform, and the good experience using the new delivery system for patients with challenging anatomies, made the company and the investigators confident in EluNIR’s potential ability to perform well,” she said.

To test this potential, the BIONICS and NIREUS studies were born,2,3 the one-year outcomes of which Dr Musumeci will convey to the JIM

audience during the session. “The BIONICS study, a global, prospective, randomised, multicentre, non-inferiority clinical trial was designed to include a ‘more comers’ popula-tion, i.e. one that closely represents

the real-world patient population,” he said. “The EluNIR stent (study name BioNIR™) was compared to the Resolute Integrity™ [Medtronic, USA] Stent (1:1 randomisation), and the study enrolled 1,919 patients from 76 sites in eight countries.

DES Manzoni Thursday 12:45–14:15

One-year follow-up for novel elastomeric DES laid bare

Caption

“The [BIONICS and NIREUS] results establish the excellent clinical performance of this stent.”

Giuseppe Musumeci

Continued on page 12

Figure 1. Scanning electron micrographs of EluNIR’s elastomer coating, showing long-term surface integrity.4

Figure 2. A) EluNIR’s spring tip; B) The EluNIR stent.4

“EluNIR is coated with an elastomer that maintains a smooth and uniform surface designed to prevent the pro-inflammatory cracking or peeling that may occur with brittle polymers.”

Giuseppe Musumeci

Alaide Chieffo

A B


“The NIREUS study, a prospective, multi-centre, randomised, non-inferiority pivotal study comparing EluNIR to the Resolute Integrity Stent, met its non-inferiority primary endpoint of an-giographic in-stent late loss at six months.”

As Dr Musumeci detailed, for BIONICS’s primary endpoint of target lesion failure (TLF), EluNIR matched the Resolute Integrity, with a rate of 5.4% at 12 months (p=0.0013 for non-inferiority). TLF was defined as the composite of cardiac death, target

vessel MI, and clinically-driven TLR. In addition, there was a “good” safety profile, with a low definite/probable

stent thrombosis rate of 0.4% for EluNIR, compared to 0.8% for Reso-lute (p=NS) with no events beyond 30 days for EluNIR. Importantly, late stent

thrombosis was zero in the EluNIR arm, versus 0.3% for Resolute.

He added: “In the NIREUS study, the twelve-month clinical data showed a TLF of 3.4% for EluNIR and 5.9% for Resolute (p=NS). These outcomes were consistent with the positive results of BIONICS. The BIONICS and NIREUS data validated that the EluNIR stent performed very well in all-comers population.”

He concluded: “These results establish the excellent

clinical performance of this stent. Now we need long-term data, and a relationship between safety and dual antiplatelet therapy interruption.”

Dr Chieffo added her closing thoughts: “First and foremost, EluNIR demonstrated well clinically, with low rates of TLF and angiographic in-stent late loss, in two large, randomised trials. In addition, the elastomeric coating might respond to concerns raised by interventional cardiologists about the surface quality of stents that use ‘brittle’ polymers.”Reference

1. http://www.medinol.com/us/products/elunir%E2%84%A2

2. ClinicalTrials.gov. Angiography Study of BioNIR Drug Eluting Stent System (NIREUS). NCT01995500

3. ClinicalTrials.gov. Study of BioNIR Drug Eluting Stent System in Coronary Stenosis (BIONICS). NCT01995487

4. Images supplied with courtesy from Dr Chieffo.

DES Manzoni Thursday 12:45–14:15


“EluNIR might offer clinical advantages such as better endothelialisation and lower rates of inflammation, stent thrombosis and restenosis.”

Alaide Chieffo

One-year follow-up for novel elastomeric DES laid bare


A djunctive use of Pressure-controlled intermittent Coronary Sinus Occlusion (PiCSO; Miracor Medical Systems, Austria)

in primary PCI improves functional recovery after STEMI, delegates will hear in tomorrow’s ‘DES and optimisation technology’ symposium.

The PiCSO system redistributes blood flow into the microcirculation after PCI, improving coronary perfusion in the ischaemic zone, reduc-ing infarct size.1 Discussing the system and its results will be Mohaned Egred (Freeman Hospital, Newcastle upon Tyne, UK), who spoke to JIM Today to first frame the problem with traditional PCI and STEMI. “Dedicated STEMI networks, po-tent antithrombotic drugs, rapid achievement of reperfusion, and advanced secondary prevention programmes resulted in a decline in morbidity and mortality in STEMI patients,” he said.

“However, it is well recognised that myocardial tissue perfusion remains compromised in 30-40% of STEMI patients, despite rapid and successful mechanical revas-cularisation. This phenomenon is associated with larger post-infarc-tion myocardial necrosis, which is a major determinant of morbidity and mortality in STEMI survivors.”

Touching upon what strate-gies are employed to protect the microcirculation in contemporary STEMI care, he continued: “They are focused on embolic and

thrombotic impairment of tissue perfusion to reduce infarct size and improve outcomes, and

include the use of thrombus aspiration, novel an-ticoagulants, adjuvant anticoagulation regimens, and advanced stent designs.”

PiCSO – applied after flow restoration and during stenting – runs automatically, using an algorithm to intermittently inflate and deflate a balloon according to a patient’s individual anatomy and haemodynamic pressure.2 “This intermittent coronary sinus pressure change helps to effectively distribute blood into the deprived myocardium, and washes out toxins from the infarcted region,” said Dr Egred.

Referring to earlier data in support of PiCSO’s potential, Dr Egred relayed that studies in animals as well as humans using a “predecessor” technol-ogy consistently showed that intermittent coronary sinus occlusion results in reduction of final infarct size. “Miracor Medical Systems has leveraged this technology to create a the PiCSO Impulse System, which has been used in several clinical studies that have shown promising results,” he added.

This has led to a prospective, parallel controlled, multi-centre clinical evaluation of the PiCSO Impulse System in STEMI patients, with the key ob-jective of evaluating the impact of PiCSO on infarct size. Currently in the final phase of recruitment, up to 70 STEMI patients will be enrolled in four clinical sites in the UK, and patients will be allocated to PCI + PiCSO or PCI only.2

Interim results from the trial will be exhibited by Dr Egred during tomorrow’s ‘Adjunctive technologies’ session, taking place in Room Club at 12:45–14:15.

References

1. Egred M, et al. Pressure-controlled intermittent Coronary Sinus Occlusion (PiCSO) reduces Infarct Size and results in Functional Recovery after STEMI. TCT 2016.

2. Zaman AG. PiCSO to Improve Myocardial Salvage and Reduce Infarct Size in STEMI: Emerging Data. TCT 2016.


PiCSO poised to reduce infarct size and improve STEMI recovery

“[PiCSO’s] intermittent coronary sinus pressure change helps to effectively distribute blood into the deprived myocardium, and washes out toxins from the infarcted region.”

Mohaned Egred


Floorplan

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Room Club

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Company StandAbbott 7

Abiomed Europe 1

Alvimedica 19

Biosensors Europe 17

Boston Scientific 11

Bracco Imaging Italia 12

Cardio Alex 2017 A

CRF - Cardiovascular Research Foundation F

Cardiovascular News B

Cascina Pastori- Wine Corner

CLI Foundation - Rome Heart Research E

Correvio 18

E-Casebook M

Endotech 10

Ercules Comunicazioni G

Fondazione Evidence I

Infraredx 7 Bis

Innova HTS 16

Kardia 2-3

MCR H

Medtronic 6

Minerva Medica D

Occlutech Italia 13

Orbus International 5

RA Medical Systems C

SEDA 4

Spectranetics International 14

St Jude Medical Italia 20

Terumo 8

Valtech Cardio 15

Wisepress Medical Bookshop L


Faculty membersCOURSE DIRECTORS

ANTONIO COLOMBO MD

EBERHARD GRUBE MD

MARTIN B. LEON MD

CARLO DI MARIO MD

JEFFREY W. MOSES MD

GREGG W. STONE MD

ASSOCIATE DIRECTORS

ALEXANDRE C. ABIZAID MD

SEUNG JUNG PARK MD

NICOLAS VAN MIEGHEM MD

STEPHAN WINDECKER MD

FACULTY MEMBERS

San Raffaele Hospital Milan

FACULTY AND OPERATORS

ANTONIO COLOMBO MD

LORENZO AZZALINI MD

MAURO CARLINO MD

ALFREDO CASTELLI MD

ALAIDE CHIEFFO MD

FRANCESCO GIANNINI MD

AZEEM LATIB MD

MATTEO MONTORFANO MD

Fellows and Research Associates

MARCO ANCONA MD

LUCIANO CANDILIO MD

GIULIANA CAPRETTI MD

ANTONIO MANGIERI MD

SATORU MITOMO MD

DAMIANO REGAZZOLI MD

AKIHITO TANAKA MD

Cardiothoracic Department

OTTAVIO ALFIERI MD - Section Director

ANDREA BLASIO MD

ALESSANDRO CASTIGLIONI MD

MICAELA CIONI MD

MICHELE DE BONIS MD

PAOLO DENTI MD

DAVID FERRARA MD

GIUSEPPE IACI MD

GIOVANNI LA CANNA MD

ELISABETTA LA PENNA MD

STEFANO MORIGGIA MD

SIMONA NASCIMBENE MD

ALESSANDRO VERZINI MD

Cardiology and Intensive Coronary Care Sections

ALBERTO MARGONATO MD - Section Director

EUSTACHIO AGRICOLA,MD

CARLO BALLAROTTO MD

ALBERTO CAPPELLETTI MD

ANDREA CONVERSANO MD

COSMO GODINO MD

VALERIA MAGNI MD

MICHELE OPIZZI MD

GIUSEPPE PIZZETTI MD

STEFANO STELLA MD

Vascular Surgery Section

ROBERTO CHIESA MD - Section Director

LUCA APRUZZI MD

DOMENICO ASTORE MD

DOMENICO BACCELLIERI MD

LUCA BERTOGLIO MD

RENATA CASTELLANO MD

BARBARA CATENACCIO MD

ETTORE DINOTO MD

GLORIA ESPOSITO MD

ANDREA LUITZ KAHLBERG MD

DILETTA LOSCHI MD

DANIELE MASCIA MD

GERMANO MELISSANO MD

ENRICO RINALDI MD

SARA SPELTA MD

YAMUME TSHOMBA MD

Anaesthesiology and Cardiovascular Intensive Care Section

ALBERTO ZANGRILLO MD - Section Director

ELENA BIGNAMI MD

TIZIANA BOVE MD

MARTINA CRIVELLARI MD

FABRIZIO MONACO MD

ANNALISA FRANCO MD

CHIARA GERLI MD

GIULIA MAJ MD

FEDERICO PAPPALARDO MD

MARA SCANDROGLIO MD

Columbus Hospital Heart Center Milan


ANTONIO COLOMBO MD

BRUNO DAMASCELLI MD

LEO FINCI MD

AZEEM LATIB MD

GLORIA MELZI MD

Fellow and Research Associates

LUCIANO CANDILIO MD

SATORU MITOMO MD

AKIHITO TANAKA MD

Cardiology and Intensive Coronary Care Sections

RAFFAELLA ALPAGO MD

GIANCARLO BIAGI MD

ALFREDO CASTELLI MD

FEDERICA DELLA ROCCA MD

Anaesthesiology Department

ROMEO ARIENTA MD

STEFANO FATTORE MD

ALBERTO MARAZZI MD

STEFANO TREDICI MD

PIERLUIGI VILLA MD

University Hospital Bonn


EBERHARD GRUBE MD

GEORG NICKENIG MD

ROBERT SCHÜLER MD

JAN MALTE SINNING MD

NIKOS WERNER MD

Cardiovascular Surgery Department

ARMIN WELZ MD

FRITZ MELLERT MD

WOLFGANG SCHILLER MD

Anaesthesiology Department

ANDREAS HOEFT MD

STEFAN WEBER MD

INVITED FACULTY

A

ALEXANDRE C. ABIZAID MD Sao Paulo - Brazil

EUSTACHIO AGRICOLA MD Milan - Italy

OTTAVIO ALFIERI MD Milan - Italy

YARON ALMAGOR MD Jerusalem - Israel

DOMINICK J. ANGIOLILLO MD Jacksonville FL - USA

DAVID ANTONIUCCI MD Florence - Italy

B

MARCO BARBANTI MD Catania - Italy

ANTONIO BARTORELLI MD Milan - Italy

FRANCESCO BEDOGNI MD Milan - Italy

SERGIO BERTI MD Massa - Italy

JOHN BINOY MD Chennai - India

CARLO BRIGUORI MD Naples - Italy

TODD BRINTON MD Stanford CA - USA

LUTZ BUELLESFELD MD Bonn - Germany

ROBERT BYRNE MD Munich - Germany

C

DAVIDE CAPODANNO MD Catania - Italy

MAURO CARLINO MD Milan - Italy

FAUSTO CASTRIOTA MD Cotignola RA - Italy

ALAIDE CHIEFFO MD Milan - Italy

BERNARDO CORTESE MD Milan - Italy

ALBERTO CREMONESI MD Cotignola RA - Italy

D

KEITH DAWKINS MD London - UK

PAOLO DENTI MD Milan - Italy

CARLO DI MARIO MD Florence - Italy

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MOHANED EGRED MD Newcastle upon Tyne - UK

F

TED FELDMAN MD Evanston IL - USA

MARCO FERLINI MD Pavia - Italy

G

ANDREA GAGNOR MD Turin - Italy

ROBERTO GARBO MD Turin - Italy

FRANCESCO GIANNINI MD Milan - Italy

COSMO GODINO MD Milan - Italy

OMER GOKTEKIN MD Istanbul - Turkey

CARMELO GRASSO MD Catania - Italy

ADAM GREENBAUM MD Detroit MI - USA

H

MICHAEL HAUDE MD Neuss - Germany

JONATHAN HILL MD London - UK

I

CIRO INDOLFI MD Catanzaro - Italy

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PAUL HSIEN-LI KAO MD Taipei City - Taiwan

SASHKO KEDEV MD Skopje - Macedonia

HAZEM KHAMIS MD 6th of October City - Egypt

FELIX KREIDEL MD Hamburg - Germany

L

AZEEM LATIB MD Milan - Italy

MARTIN B. LEON MD New York NY - USA

M

ROXANA MEHRAN MD New York NY - USA

OSCAR MENDIZ MD Buenos Aires - Argentina

ALBERTO MENOZZI MD Parma - Italy

GHADA MIKHAIL MD London - UK

JEFFREY W. MOSES MD New York NY - USA

GIUSEPPE MUSUMECI MD Cuneo - Italy

N

SUNAO NAKAMURA MD Tokyo - Japan

O

YOSHINOBU ONUMA MD Rotterdam - The Netherlands

P

TULLIO PALMERINI MD Bologna - Italy

ANNA SONIA PETRONIO MD Pisa - Italy

AUGUSTO PICHARD MD Washington DC - USA

FRANCESCO PRATI MD Rome - Italy

PATRIZIA PRESBITERO MD Turin - Italy

R

BERNHARD REIMERS MD Rozzano MI - Italy

ENRICO ROMAGNOLI MD Viterbo - Italy

RAFAEL ROMAGUERA MD Barcelona - Spain

ROBERTA ROSSINI MD Bergamo - Italy

S

GENNARO SARDELLA MD Rome - Italy

JOACHIM SCHOFER MD Hamburg - Germany

DINESH SHAH MD Berkley MI - USA

GEORGIOS SIANOS MD Thessaloniki - Greece

HORST SIEVERT MD Frankfurt - Germany


MOHAMED AHMED SOBHY MD Alexandria - Egypt

GORAN STANKOVIC MD Belgrade - Serbia

GREGG W. STONE MD New York NY - USA

T

CORRADO TAMBURINO MD Catania - Italy

GIUSEPPE TARANTINI MD Padua - Italy

HENDRIK TREEDE MD Halle Saale - Germany

V

MARCO VALGIMIGLI MD Bern - Switzerland

ROBERT JAN VAN GEUNS MD Rotterdam - The Netherlands

NICOLAS VAN MIEGHEM MD Rotterdam - The Netherlands

FERDINANDO VARBELLA MD Rivoli TO - Italy

FRANCESCO VERSACI MD Rome - Italy

STEPHAN VON BARDELEBEN MD Mainz - Germany

W

MARCO WAINSTEIN MD Porto Alegre - Brazil

RON WAKSMAN MD Washington DC - USA

SIMON WALSH MD Belfast - UK

DANIEL WEILENMANN MD St. Gallen - Switzerland

Y

ALAN YEUNG MD Stanford CA - USA

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