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J.Schneider, how tryton will change daily practice

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J.Schneider, how tryton will change daily practice

  1. 1. How  Tryton  Will  Change  Daily  Practice Joel  Schneider,  MD  FACC UNC-­Rex  Healthcare Raleigh,  NC Tryton  Medical  TCT  Symposium October  31,  2016 “create  order  out  of  chaos”
  2. 2. Disclosure  Statement  of  Financial  Interest I,  Joel  Schneider,  MD  do  not  have  a  financial  interest/arrangement  or   affiliation  with  one  or  more  organizations  that  could  be  perceived  as  a  real  or   apparent  conflict  of  interest  in  the  context  of  the  subject  of  this  presentation.
  3. 3. “Cognizant  of   economics   and  his  resource  use” “Constantly  trying  to  learn   and  improve  his  skills” “Essential  that  he  is  efficient,   effective,  and  focused   on  patient  care” Age:  55years  old Family:    2  grown  children Experience:  20+  years “It’s  a  calling  when  you  do  this  for  a    living…”
  4. 4. What  does  Carl  want  from  Tryton • New  approach  to  bifurcation  PCI • Predictability  and  Improved  Outcomes • Cost  Neutral  or  Defensible  
  5. 5. Dilemma  of  Bifurcation  Disease   vs
  6. 6. CONFIDENTIAL  – NOT  FOR  DISTRIBUTION • Methodology  not  established • Technically  complex • Unpredictable  results • Increased  procedural  time • Higher  costs • Increased  risk  for  stent  thrombosis • Recurrent  ischemia  from  side  branch   residual  disease • Higher  restenosis  rate • Duration  of  DAPT  unclear • Repeat  intervention  options  limited • Procedural  Concerns • Post  Procedural  Concerns Clinical  Dilemma  of  Bifurcation  Disease  
  7. 7. Tryton  takes  the  side  branch  out  of  play …Avoids  the  unpredictable  nature  of  BIF  and  its  consequences
  8. 8. Eliminate  Two  Stent  Strategies  for  Bifurcation T Stenting V Stenting Y Stenting Culotte * Crush* Kissing Stent* *”gap” coverage
  9. 9. RCT  and  Confirmatory  Study  Combined Tryton  (n=  279) Tryton:    Side  Branch  Status
  10. 10. “All  Comers”  Studies %  Patients %  Lesions Leaders  Trial1,2 29.1% 21.6% Nobori  23 17.5% 16.9% xSearch4 22.2% N/A Average 22.9% 19.3% 1.  Windecker  et  al. Lancet  2008;;  372:  1163–73 2.  Wykrzykowska,  EuroPCR  ’09 3.  Danzi,  EuroPCR  ‘09 4.  Serruys,  ACC  ‘08 How  often  will  bifurcations  come  up  in  clinical  practice?
  11. 11. Bifurcation Total  PCI   Volume Total 360 3,492 10.3% UNC-­Rex 283 2,716 10.4% Medical   Center 77 776 9.9% National 108,672 979,245 11.1% BIFURCATION  PCI  NCDR  DATA CY  2015 US  Potential  Usage  Estimated    @  15%:        146,886  Implants  
  12. 12. BIFURCATION  LESIONS  at  UNC-­Rex  and   Medical  Center 1.41 2 1.36 2 1.41 2 0 0.5 1 1.5 2 2.5 REX UNC Average  Number  of  Stents  per  Bifurcation  Lesion Average  Stents  per  Lesion 2014 2015 2016
  13. 13. Bifurcation  Cost  Considerations Values Bifucated  Lesion   Other  PCI   Grand  Total   Count  of  Account  Number/HAR 210   1,563   1,773   Average  of  Total  Payments  and   Settlements 18,354   16,399   16,631   Average  of  Implant  Cost  (1DV) 2,633   2,435   2,459   Average  of  Drug  Cost  (3DV) 610   531   541   Average  of  Total  Variable  Cost  (incl.   Implant  and  drug) 10,273   9,286   9,403   Average  of  Contribution  Margin 8,082   7,113 7,228   Average  of  Operating  Income  (Loss)   w  Settlements 1,578   1,511   1,519   Average  of  IP  Days  (Length  of  stay) 1.9   1.9   1.9  
  14. 14. 2013  Tryton  OUS  Experience: >12.000  Patients  Treated  in  >  30  Countries >1.800  Patients  Studied  by  >  80  Physicians
  15. 15. The  Tryton  in  the  Hat? “create  order  out  of  chaos”
  16. 16. Tryton  Experience:    Learning  Curve Faster  procedures,  Reduced  Fluoroscopy,  and  Less  Contrast   as  Experience  Grows

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