NY STATE NPA 33 rd Annual Conference TAVR & Structural Heart Update
|
|
- Britton Bradley
- 6 years ago
- Views:
Transcription
1 NY STATE NPA 33 rd Annual Conference TAVR & Structural Heart Update October 21, 2017 Rose Hansen DNP Structural Heart Coordinator Gates Vascular Institute, Buffalo NY TAVR Update: Objectives 1. Understand Aortic Stenosis disease process, prognosis and prevalence 2. Explore treatment options: TAVR, SAVR, BAV 3. Define new TAVR trends: Low Risk Patients, Carotid protection 4. Understand Patient Screening Process and Selection 5. Understand TAVR Program Challenges and Structural Heart Expansion 2 Structural Heart Update: Objectives Mitral Stenosis Prognosis and treatment options Mitral Regurgitation prognosis and treatment options Transcatheter Mitral Repair with Mitraclip for Severe Degenerative Mitral regurgitation Explore FDA Approved Watchman device for patients with Atrial Fib at high risk for CVA and Bleeding Cryptogenic Stroke associated with PFO/ASD may benefit from Closure HOCM treatment with Alcohol Septal Ablation 3 1
2 TAVR for Aortic Stenosis Age-related calcific aortic stenosis Symptoms of Aortic Stenosis Shortness of breath Angina Fatigue Syncope or Presyncope Other Rapid or irregular heartbeat Palpitations Sandy Severe Aortic Stenosis (Actual Patient) The symptoms of aortic disease are commonly misunderstood by patients as normal signs of aging. 5 Many patients initially appear asymptomatic, but on closer examination up to 37% exhibit symptoms Das P. European Heart Journal. 2005;26: ; 6. Lester SJ et al. CHEST 1998;113(4): Population at Risk for Aortic Stenosis is Increasing Approx. 2.5 Million People in the U.S. Over the Age of 75 suffer from this disease. 1 Aortic Stenosis is estimated to be prevalent with 12.4% of the population over the age of The elderly population will more than double between now and the year 2050, to 80 million. 3 80% of adults with symptomatic aortic stenosis are male 4 4.0% 3.0% 2.0% 1.0% 0.0% ELDERLY AVERAGE ANNUAL GROWTH RATE: 1910 to % 3.1% 2.4% 2.2% 1.3% 2.8% 1. U.S. Census Bureau, Population Division. June 2015; 2. Ruben L.J.et al. Heart. 2000;84:211-21; 3. U.S. Census Bureau Statistical Brief. May 1995; 4. Ramaraj R, Sorrell VL. Br Med J 2008;336:
3 Severe Aortic Stenosis Is a Life Threatening Rapidly Progressing Disease Process Otto, CM, 2000 After the onset of symptoms, patients with severe aortic stenosis have a survival rate as low as 50% at 2 years and 20% at 5 years without aortic valve replacement 2 7The PARTNER Trial demonstrated that 50% of inoperable patients died within 1 year without a valve replacement Survival (%) Severe aortic stenosis has a worse prognosis than many metastatic cancers severe inoperable AS* 5-YEAR SURVIVAL (Distant Metastasis) lung cancer 12 colorectal cancer 23 breast cancer 28 ovarian cancer 30 prostate cancer 5-year survival of breast cancer, lung cancer, prostate cancer, ovarian cancer and severe inoperable aortic stenosis 8 *Using constant hazard ratio. Data on file, Edwards Lifesciences LLC. Analysis courtesy of Murat Tuczu, MD, Cleveland Clinic 2014 AHA/ACC Valvular Heart Disease Guidelines Symptomatic Severe Aortic Stenosis * NYHA Class II Symptoms include: Dyspnea, decreased exercise tolerance, CHF, angina, presyncope & syncope Patients with severe aortic stenosis typically have an aortic valve area 1.0 cm 2 Stage Definition Valve Hemodynamics Hemodynamic Consequences D: Symptomatic Severe Aortic Stenosis D1 High-gradient Aortic jet velocity 4m/s or mean gradient 40 mmhg Or aortic valve area index 0.6 cm 2 /m 2 Left ventricular diastolic dysfunction Left ventricular hypertrophy Pulmonary hypertension may be present D2 Low-flow/lowgradient with reduced left ventricular ejection fraction Resting aortic jet velocity < 4m/s or mean gradient < 40 mmhg Dobutamine stress echocardiography shows aortic valve area 1.0 cm 2 with aortic jet velocity 4m/s at any flow rate Left ventricular diastolic dysfunction Left ventricular hypertrophy Left ventricular ejection fraction < 50% D3 Low-gradient with normal left ventricular ejection fraction or paradoxical low-flow Aortic jet velocity < 4m/s or mean gradient < 40 mmhg Indexed aortic valve area 0.6 cm 2 /m 2 Stroke volume index < 35 ml/m 2 measured when patient is normotensive (systolic blood pressure < 140 mmhg) Increased left ventricular relative wall thickness Small left ventricular chamber with low stroke volume Restrictive diastolic filling Left ventricular ejection fraction 50% 3
4 10 A collaborative treatment decision 1 Patient with severe aortic stenosis identified by referring physician 2 Patient referred to valve clinic Devising a treatment plan is a collaborative process 5 Ultimate treatment choice is a collaborative decision between the physicians, patient and patient s family. Treatment recommendations reviewed with referring physician, patient 4 and patient s family 3 Additional testing completed Multidisciplinary review and treatment decision by Heart Team 11 TAVR Pre-Operative Workup 2D Echo Right & Left Heart Cath 100cc IV Contrast CTA Torso (70cc IV contrast) PFTs Carotid Doppler Chest-X-Ray EKG Lab work/mrsa swab (TEE optional) Functional Assessment 4
5 TAVR Pre-Operative Workup Clinic Visit 2-3 times prior CT Surgery Consult CT Surgery Consult Second Opinion (Separate Date) Vascular Surgery Consult Anesthesia Consult Consult for all other co-morbidities Renal, Oncology, Neurology, Dental, PT, OT, ect Discussed in a multidisciplinary forum and deemed candidate for TAVR/SAVR If not a candidate: BAV or Palliative care TAVR Workup is extensive and geared to obtain mandatory registry reported data. 30 day and 1 year reports. TRANSCATHETER AORTIC VALVE REPLACEMENT TAVR Alain Cribier: First human transcatheter valve replacement (2002) 15 5
6 ORIGINAL PARTNER Trial Significant reduction in mortality for inoperable patients with patients with the SAPIEN valve All-Cause Mortality (%) All-cause mortality inoperable cohort 93.6% 100 Standard Rx (n = 179) TAVR (n = 179) % % 40 HR [95% CI] = 0.50 [0.39, 0.65] % p (log rank) < Months Of the 358 patients 94% of patients in the standard therapy group died within 5 years 21.8% absolute reduction in mortality at 5 years 16 Standard therapy includes medical management and BAV The PARTNER II Trial: Intermediate-risk Intermediate-risk symptomatic severe aortic stenosis Intermediate-risk assessment by Heart Valve Team PARTNER II S3i ( n = 1078 ) PARTNER IIA ( n = 2032 ) Assessment for optimal valve delivery access Ye s Assessment transfemoral access No Transfemoral (TF) Transapical (TA)/ Transaortic (TAo) Transfemoral (TF) 1:1 Randomization Transapical (TA)/ Transaortic (TAo) 1:1 Randomization TF TAVR SAPIEN 3 valve TA / TAo TAVR SAPIEN 3 valve TA TAVR SAPIEN XT valve vs Surgica l AVR TA/TAo TAVR SAPIEN XT valve vs Surgica l AVR The most robust, rigorous study in more than 3,000 intermediaterisk patients 17 Disabling Stroke* 40 Surgery (PIIA) TAVR with SAPIEN 3 valve Disabling stroke (%) % 1.0% % 5.9% 1.0% 2.3% Number at risk: Months from procedure Surgery SAPIEN 3 TAVR *The PARTNER II trial intermediate-risk cohort unadjusted clinical event rates. Leon M et al. New England Journal of Medicine
7 Backed by unprecedented outcomes and real world results INTERMEDIATE RISK TAVR APPROVAL 8/2016 Over 150,000 patients treated worldwide Over 50,000 patients treated in the United States Treating patients in Over 65 countries 19 *As of February 2016 Gates Vascular Institute TAVR Program TAVR First Case 1/11/12 >675 TAVRs to date Edwards Medtronic Boston Scientific Research:Partner3, Reprise3 Transfemoral (Percutaneous 2012) MAC~ 1/1/2015 Alternate Approach 2013 >85 cases Transapical/Direct Aortic/Axillary/Subclavian Carotid Approach=14 Valve in Valve, ESRD HD, Bicuspid Valves 21 7
8 99 years old 5 weeks post TAVR What Else is New in the TAVR World Embolic Debris During TAVR 23 Giustino, et al 2016 Claret Sentinel Carotid Protection for Stroke Prevention during TAVR FDA Approved 8/ Giustino, et al
9 LOW RISK Patients STS <3% May Now be Eligible for TAVR Partner 3 Trial 1:1 Randomization to TAVR or SAVR Bicuspid TAVR Registry pending Early TAVR TRIAL for Asymptomatic patients 25 Minimally Invasive and Minimalist Approach 26 Performed in Hybrid Cath Lab Conscious Sedation MAC Percutaneous, No Cutdown No Swan No Art Line No Foley No ICU (for select patients) Shorter LOS Less readmission Better Outcomes STRUCTURAL HEART Mitral Stenosis Severe NYHA Class CHF symptoms Poor prognosis Surgery high Risk due to calcification FDA Approval of TAVR in Mitral position ina previous place surgical valve 2017 Native TMVR in trial Balloon Mitral Valvotomy Palliative 27 9
10 STRUCTURAL HEART Mitral Regurgitation and Mitraclip Severe degenerative Mitral Regurgitation is a progressive disease leading to CHF and functional decline Diagnosis with TEE Right and Left Heart Cath For inoperable or high risk patients transcatheter percutaneous transeptal Mitral Valve Repair with MitraClip can decease Severe MR 28 STRUCTURAL HEART LAAO WATCHMAN DEVICE Atrial Fibrillation treatment includes anticoagulation for prevention of left atrial appendage thrombus increasing stroke risk. For Patients at high risk for Bleeding a percutaneous LAA occluder device WATCHMAN may be inserted to reduce risk Preoperative Warfarin, TEE and General anesthesia, Cath Lab or EP Lab Follow up Registry Reporting x4 29 STRUCTURAL HEART Cryptogenic CVA with PFO/ASD PFO/ASD Prevalence in 25% of population Cause shunting of right to left turbulence clotting and embolic events Causes left to right ishunting ncreasing the right atrial pressures and PHTN 2017 approval of ASD/PFO Closure in presence of cryptogenic stroke Diagnosis Bubble study echo, transcranial doppler, Rule out atrial fib holter monitor and hypercoagulable studies 30 10
11 Maria 103 years old 4 weeks post TAVR STRUCTURAL HEART Hypertrophic Obstructive Cardiomyopathy HOCM is an enlargement of the left ventricular outflow tract Symptoms mimic Aortic Stenosis increae risk of Sudden death, familial Diagnosis 2D Echo/ Cardiac MRI & Left heart Cath Treatment: Surgical Myectomy Open Heart Surgery Alcohol Septal ablation is performed in the Cath lab under general anesthesia Induces an infarct to the upper septal wall reducing the septum Requires ICU and post op pain management Recommend AICD 32 Structural Heart Summary Patients with Mitral Stenosis have limited treatment options and can be extremely symptomatic. Severe Mitral Regurgitation has a poor prognosis and limited treatment options Transcatheter Repair with Mitraclip is an effective option for high risk patients with Severe Mitral regurgitation Watchman device is an appropriate option for patients with Atrial Fib at high risk for CVA and Bleeding Patients with Cryptogenic Stroke and PFO/ASD may benefit from FDA Approved Closure HOCM increases risk of Sudden death an may be treated with Alcohol Septal Ablation 33 11
12 TAVR Summary Aortic stenosis is prevalant in elderly populations and has a poor prognosis if left untreated TAVR is effective treatment for High risk and Inoperable patients TAVR is effective treatment in Intermediate Risk Patients ALL Aortic Stenosis Patients Should Be Evaluated By the Heart Team: Low Risk Patients should be offered Trial CVA Protection is Available for at Risk patients Minimalist approach provides less complications and Shorter LOS 34 Questions? Thank You! Rhansen@Daemen.edu References 1. Nkomo 2006, Iivanainen 1996, Aronow 1991, Bach 2007, 2014 internal estimates 2. Freed 2010, Iung 2007, Pellikka 2005; 2014 internal estimates 3. Das P. European Heart Journal. 2005;26: Giustino, Gennaro, Cerebral Embolic Protection During TAVR. JACC Intervention DOI: /j.jacc Lester SJ et al. CHEST 1998;113(4): Otto CM. Timing of aortic valve surgery. Heart. 2000;84: Nishimura RA et al. JACC doi: /j.jacc Dumesnil et al. European Heart Journal 2010; 31, Nishimura RA et al. JACC doi: /j.jacc National Coverage Determination (NCD) for Transcatheter Aortic Valve Replacement (TAVR) Leon M et al. New England Journal of Medicine 2010 October 21;363(17): Nishimura RA et al. JACC doi: /j.jacc Abbott Vascular Everest Trial MitraClip 13 Boston Scientific Watchman 13. St Jude Amplatzer PFO/ASD Closure 36 12
The Transcatheter Aortic Valve Replacement (TAVR)Program at Southcoast Health. Adam J. Saltzman, MD Cardiovascular Care Center
The Transcatheter Aortic Valve Replacement (TAVR)Program at Southcoast Health Adam J. Saltzman, MD Cardiovascular Care Center Southcoast Health Disclosures Edwards Lifesciences: speaking honorarium Outline
More informationTranscatheter Valve Replacement: Current State in 2017
Transcatheter Valve Replacement: Current State in 2017 Marc A. Sintek MD Assistant Professor of Medicine Interventional Cardiology Cardiovascular Division Washington University in St. Louis Missouri ACP
More informationTranscatheter Valve Therapies Update
Providence Heart and Vascular Institute Transcatheter Valve Therapies Update Where In The H*@# Is All This Going??? Robert Hodson MD Medical Director, Providence Valve Center October 24, 2015 DISCLOSURES
More informationTranscatheter Aortic Valve Replacement
Transcatheter Aortic Valve Replacement Jesse Jorgensen, MD Medical Director, Cardiac Catheterization Laboratory Greenville Health System Greenville, South Carolina, USA January 30, 2016 Aortic Stenosis
More informationA new option for the Diagnosis and Management of Valvular Heart Disease. Oregon Comprehensive Valve Center
A new option for the Diagnosis and Management of Valvular Heart Disease Oregon Comprehensive Valve Center I have no disclosures Oregon Comprehensive Valve Center Weekly multidisciplinary case conferences
More informationAortic Valve Stenosis and TAVR: Putting it all together.
Aortic Valve Stenosis and TAVR: Putting it all together. Maria L. Held, MSN CNS Valve Clinic Coordinator at The Cleveland Clinic Alliance of Cardiovascular Professionals April 14 th, 2018 Brief Anatomy
More informationIgor Palacios, MD Director of Interventional Cardiology Massachusetts General Hospital Professor of Medicine Harvard Medical School
Aortic Stenosis: Current State of Percutaneous Therapies, Emerging Technologies and Future Directions Igor Palacios, MD Director of Interventional Cardiology Massachusetts General Hospital Professor of
More informationThe Worshipful Company of Barbers. Mr. John Hunter. History of cardiac surgery. PDA ligation. Blalock-Taussig Shunt
The Worshipful Company of Barbers Puneet Dhawan M.D Assistant Health Sciences Clinical Professor David Geffen School of Medicine at UCLA Assistant Chief Division of Cardiothoracic Surgery Harbor-UCLA Medical
More informationIncorporating the intermediate risk in Transcatheter Aortic Valve Implantation (TAVI)
Incorporating the intermediate risk in Transcatheter Aortic Valve Implantation (TAVI) Larry S. Dean, MD, MSCAI Past President SCAI Professor of Medicine and Surgery University of Washington School of Medicine
More informationAn Update on the Edwards TAVR Results. Zvonimir Krajcer, MD Director, Peripheral Intervention Texas Heart Institute at St.
An Update on the Edwards TAVR Results Zvonimir Krajcer, MD Director, Peripheral Intervention Texas Heart Institute at St. Luke s Hospital Disclosures On the speaker s bureau for Endologix, TriVascular,
More information2/15/2018 DISCLOSURES OBJECTIVES. Consultant for BioSense Webster, a J&J Co. Aortic stenosis background. Short history of TAVR
TRANSCATHETER AORTIC VALVE REPLACEMENT IN 2018: IS IT NOW THE STANDARD OF CARE? 22 ND ANNUAL COASTAL CARDIAC & VASCULAR CONFERENCE FEBRUARY 17, 2018 R. David Anderson, MD, MS, FACC, FSCAI Professor of
More informationTranscatheter Aortic Valve Replacement: Current and Future Devices: How do They Work, Eligibility, Review of Data
Transcatheter Aortic Valve Replacement: Current and Future Devices: How do They Work, Eligibility, Review of Data Echo Florida 2013 Jonathan J. Passeri, M.D. Co-Director, Heart Valve Program Director,
More informationTAVR IN INTERMEDIATE-RISK PATIENTS
TAVR IN INTERMEDIATE-RISK PATIENTS K. Lampropoulos MD, PhD, FESC, MEAPCI Interventional Cardiologist Evangelismos General Hospital The Burden of Valve Disease Prevalence Survival NATURAL HISTORY OF AS
More informationUpdate on Percutaneous Therapies for Structural Heart Disease. William Thomas MD Director of Structural Heart Program Tucson Medical Center
Update on Percutaneous Therapies for Structural Heart Disease William Thomas MD Director of Structural Heart Program Tucson Medical Center NCVH 2014- Tucson Disclosure of Financial Interest Research: Stock
More informationTAVR-Update Andrzej Boguszewski MD, FACC, FSCAI Vice Chairman, Cardiology Mid-Michigan Health Associate Professor Michigan State University, Central
TAVR-Update Andrzej Boguszewski MD, FACC, FSCAI Vice Chairman, Cardiology Mid-Michigan Health Associate Professor Michigan State University, Central Michigan University 1 Disclosure Chiesi Pharma- Consultant
More informationTAVR in Intermediate Risk Populations /Optimizing Systems for TAVR
TAVR in Intermediate Risk Populations /Optimizing Systems for TAVR Saibal Kar, MD, FACC, FAHA, FSCAI Professor of Medicine Director of Interventional Cardiac Research Smidt Heart Institute, Cedars-Sinai
More informationTAVI After PARTNER-2 : The Hamilton Approach
TAVI After PARTNER-2 : The Hamilton Approach James L. Velianou MD FRCPC Interventional Cardiology Hamilton General Hospital St Catharines General Hospital Associate Professor of Medicine McMaster University
More informationCIPG Transcatheter Aortic Valve Replacement- When Is Less, More?
CIPG 2013 Transcatheter Aortic Valve Replacement- When Is Less, More? James D. Rossen, M.D. Professor of Medicine and Neurosurgery Director, Cardiac Catheterization Laboratory and Interventional Cardiology
More informationTAVI- Is Stroke Risk the Achilles Heel of Percutaneous Aortic Valve Repair?
TAVI- Is Stroke Risk the Achilles Heel of Percutaneous Aortic Valve Repair? Elaine E. Tseng, MD and Marlene Grenon, MD Department of Surgery Divisions of Adult Cardiothoracic and Vascular and Endovascular
More informationPERCUTANEOUS STRUCTURAL UPDATES TAVR WATCHMAN(LEFT ATRIAL APPENDAGE OCCLUDERS) MITRACLIP PARAVALVULAR LEAK REPAIRS ASD/PFO CLOSURES VALVULOPLASTIES
PERCUTANEOUS STRUCTURAL UPDATES TAVR WATCHMAN(LEFT ATRIAL APPENDAGE OCCLUDERS) MITRACLIP PARAVALVULAR LEAK REPAIRS ASD/PFO CLOSURES VALVULOPLASTIES Dr.Vinny K.Ram No disclosures TAVR 1 Lesson number 1:
More informationDisclosures. LGH TAVR: Presentation Outline 2/2/2016. Updates in Transcatheter Aortic Valve Replacement (TAVR) and the LGH Experience
Updates in Transcatheter Aortic Valve Replacement (TAVR) and the LGH Experience The LGH TAVR Program James E. Harvey, MD, MSc Medical Director, Structural Heart Intervention The Heart Group of Lancaster
More informationTAVR in 2020: What is Next!!!!
TAVR in 2020: What is Next!!!! Vinod H. Thourani, MD Professor of Surgery Chairman, Department of Cardiac Surgery Medstar Heart and Vascular Institute Washington Hospital Center Washington, DC Disclosures
More informationEstablishing the New Standard of Care for Inoperable Aortic Stenosis THE PARTNER TRIAL COHORT B RESULTS
Establishing the New Standard of Care for Inoperable Aortic Stenosis THE PARTNER TRIAL COHORT B RESULTS E D W A R D S T R A N S C A T H E T E R H E A R T V A L V E P R O G R A M T H E P A R T N E R T R
More informationStructural Heart Disease: Setting the Stage for Success
Structural Heart Disease: Setting the Stage for Success Brenda McCulloch, RN MSN RCIS Cardiovascular Clinical Nurse Specialist, Interventional & Medical Cardiology Sutter Medical Center, Sacramento mccullb@sutterhealth.org
More informationSAPIEN 3: Evaluation of a Balloon- Expandable Transcatheter Aortic Valve in High-Risk and Inoperable Patients With Aortic Stenosis One-Year Outcomes
SAPIEN 3: Evaluation of a Balloon- Expandable Transcatheter Aortic Valve in High-Risk and Inoperable Patients With Aortic Stenosis One-Year Outcomes Howard C. Herrmann, MD on behalf of The PARTNER II Trial
More informationTrans Catheter Aortic Valve Replacement
Trans Catheter Aortic Valve Replacement Satish K Surabhi, MD,FACC,FSCAI Medical Director, Cardiac Cath Labs AnMed Health Heart and Vascular Care No financial conflict of interest related to this talk Will
More informationValvular Intervention
Valvular Intervention Outline Introduction Aortic Stenosis Mitral Regurgitation Conclusion Calcific Aortic Stenosis Deformed Eccentric Calcified Nodular Rigid HOSTILE TARGET difficult to displace prone
More informationTAVI: The Real Deal? Marc Pelletier, MD Head, Department of Cardiac Surgery New Brunswick Heart Centre
TAVI: The Real Deal? Marc Pelletier, MD Head, Department of Cardiac Surgery New Brunswick Heart Centre Disclosure St. Jude Medical: Consultant and Proctor Edwards Lifesciences: Proctor Medtronic: Research
More informationTAVR today: High Risk, Intermediate Risk Population, and Valve in Valve Therapy
TAVR today: High Risk, Intermediate Risk Population, and Valve in Valve Therapy Alan Zajarias, MD FACC Structural Interventional Fellowship Director Associate Professor Medicine Cardiovascular Division
More informationIs TAVR Now Indicated in Even Low Risk Aortic Valve Disease Patients
Is TAVR Now Indicated in Even Low Risk Aortic Valve Disease Patients Saibal Kar, MD, FACC, FAHA, FSCAI Director of Interventional Cardiac Research Cedars Sinai Heart Institute, Los Angeles, CA Potential
More informationEstablishing a New Path Forward for Patients With Severe Symptomatic Aortic Stenosis THE PARTNER TRIAL CLINICAL RESULTS
Establishing a New Path Forward for Patients With Severe Symptomatic Aortic Stenosis THE PARTNER TRIAL CLINICAL RESULTS E D W A R D S T R A N S C A T H E T E R H E A R T V A L V E P R O G R A M T h e Pa
More informationAortic Stenosis: Interventional Choice for a 70-year old- SAVR, TAVR or BAV? Interventional Choice for a 90-year old- SAVR, TAVR or BAV?
Aortic Stenosis: Interventional Choice for a 70-year old- SAVR, TAVR or BAV? Interventional Choice for a 90-year old- SAVR, TAVR or BAV? Samin K Sharma, MD, FACC, FSCAI Director Clinical & Interventional
More informationAfter PARTNER 2A/S3i and SURTAVI: What is the Role of Surgery in Intermediate-Risk AS Patients?
After PARTNER 2A/S3i and SURTAVI: What is the Role of Surgery in Intermediate-Risk AS Patients? Vinod H. Thourani, MD Professor of Surgery and Medicine Emory University Disclosure Statement of Financial
More informationAortic Stenosis: Open vs TAVR vs Nothing
Aortic Stenosis: Open vs TAVR vs Nothing Wilson Y. Szeto, MD Associate Professor of Surgery Surgical Director, Transcatheter Cardio-Aortic Therapies Associate Director, Thoracic Aortic Surgery Division
More informationEvolving and Expanding Indications for TAVR
Evolving and Expanding Indications for TAVR Wilson Y. Szeto, MD Associate Professor of Surgery Surgical Director, Transcatheter Cardio-Aortic Therapies Associate Director, Thoracic Aortic Surgery Division
More informationTAVR and Cardiac Surgeons
TAVR and Cardiac Surgeons TAVR and Cardiac Surgeons Ragheb Hasan Consultant and Clinical Lead Cardiothoracic Surgeon Manchester Royal Infirmary, Oxford Road, Manchester UK Aortic Stenosis Is A Growing
More informationMITRAL STENOSIS: MANY FLAVORS Rheumatic and Calcification. Rheumatic Mitral Stenosis 76yo male
MITRAL STENOSIS: MANY FLAVORS Rheumatic and Calcification David S Rubenson MD FACC FASE Founding Director, Cardiac Non-Invasive Laboratory Scripps Clinic Medical Group number 1 Rheumatic Mitral Stenosis
More informationHeart Team For TAVI Who and How?
2 nd TAVI Summit 2012, Seoul Corea Heart Team For TAVI Who and How? Alain Cribier, MD, Charles Nicolle Hospital University of Rouen, France Disclosure Edwards Lifesciences Consultant Training / proctoring
More informationStructural Heart Disease Transcatheter Aortic Valve Replacement (TAVR)
Structural Heart Disease Transcatheter Aortic Valve Replacement (TAVR) Kathleen Harper DO FACC FACP 87 Chief, Cardiology Section VA Maine Healthcare Kathleen.Harper@va.gov Prevalence of Aortic Stenosis
More informationWatchman and Structural update..the next frontier. Ari Chanda, MD Cardiology Associates of Fredericksburg
Watchman and Structural update..the next frontier Ari Chanda, MD Cardiology Associates of Fredericksburg Different Left Atrial Appendage (LAA) morphologies Watchman (the device) Fabric Anchors Device structure
More informationLow Gradient Severe? AS
Low Gradient Severe? AS Philippe Pibarot, DVM, PhD, FACC, FAHA, FESC, FASE Canada Research Chair in Valvular Heart Diseases Institut Universitaire de Cardiologie et de Pneumologie de Québec / Québec Heart
More informationTransforming the Treatment of Aortic Valve Disease
Transforming the Treatment of Aortic Valve Disease How Do Your Heart Valves Work? Pulmonary Valve Has three leaflets. It controls blood flow from the right ventricle to the pulmonary artery, sending blood
More informationPARTNER 2A & SAPIEN 3: TAVI for intermediate risk patients
O P E N A C C E S S Department of Cardiology, Aswan Heart Centre *Email: ahmed.elguindy@aswanheartcentre.com Lessons from the trials PARTNER 2A & SAPIEN 3: TAVI for intermediate risk patients Ahmed ElGuindy*
More informationEdwards Transcatheter AVR: Have the Outcomes Changed after CE Approval?
Edwards Transcatheter AVR: Have the Outcomes Changed after CE Approval? Update from PARTNER EU and SOURCE Registries T. Lefèvre Disclosure Statement Cardiologist Interventional cardiologist 1 st PABV in
More informationHow to Prevent Thromboembolic Complications in TAVI
How to Prevent Thromboembolic Complications in TAVI PETER WENAWESER, MD Swiss Cardiovascular Centre, University Hospital, Bern, Switzerland Potential Conflicts of Interest Proctoring and lecture fees from
More informationTHE PERCUTANEOUS MANAGEMENT OF VALVULAR HEART DISEASE DR JOHN RAWLINS CONSULTANT INTERVENTIONAL CARDIOLOGIST UNIVERSITY HOSPITAL SOUTHAMPTON
THE PERCUTANEOUS MANAGEMENT OF VALVULAR HEART DISEASE DR JOHN RAWLINS CONSULTANT INTERVENTIONAL CARDIOLOGIST UNIVERSITY HOSPITAL SOUTHAMPTON INTRODUCTION History of heart valve intervention Current indications
More informationTranscatheter Aortic Valve Implantation. SSVQ November 23, 2012 Centre Mont-Royal 15:40
Transcatheter Aortic Valve Implantation SSVQ November 23, 2012 Centre Mont-Royal 15:40 Nicolo Piazza MD, PhD, FRCPC, FESC, FACC McGill University Health Center German Heart Center Munich 1 First-in-Human
More informationValvular Heart Disease Transcatheter Valve Therapies. October 2016 Brian Whisenant MD
Valvular Heart Disease Transcatheter Valve Therapies October 2016 Brian Whisenant MD Disclosure Statement of Financial Interest Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement
More informationAortic Stenosis and TAVR TARUN NAGRANI, MD INTERVENTIONAL AND ENDOVASCULAR CARDIOLOGIST, SOMC
Aortic Stenosis and TAVR TARUN NAGRANI, MD INTERVENTIONAL AND ENDOVASCULAR CARDIOLOGIST, SOMC No Financial Disclosures Aortic Stenosis AS is an insidious disease with a long latency period followed by
More informationTAVR SPRING 2017 The evolution of TAVR
TAVR SPRING 2017 The evolution of TAVR Matthew Johnson, MD Disclosers None Evolution of the Balloon- Expandable Transcatheter Valves Cribier 2002 SAPIEN 2006 SAPIEN XT 2009 SAPIEN 3 2013 * Sheath compatibility
More informationTranscatheter Therapies For Aortic Valve Disease. March 2017 Brian Whisenant MD
Transcatheter Therapies For Aortic Valve Disease March 2017 Brian Whisenant MD Introduction I got into this field to protect my turf. I must say, I have come full circle... - Kent W. Jones I got into this
More informationTAVR : Caring for your patients before and after TAVR
TAVR : Caring for your patients before and after TAVR Zubair Ahmed MD FSCAI Interventional Cardiologist Washington Regional Medical Center / Walker Heart Institute What is Aortic Valve Stenosis? AVA ~4
More informationTranscatheter Aortic Valve Replacement TAVR
Transcatheter Aortic Valve Replacement TAVR Paul Gordon, MD Associate Prof of Medicine, Brown University Director, Cardiac Catheterization Laboratory The Miriam Hospital Disclosures: none 100 Symptomatic
More informationValvular Heart Disease and Adult Congenital Intervention. A Pichard, MD. Director Cath Labs, Washington Hospital Center. Georgetown University.
Valvular Heart Disease and Adult Congenital Intervention. A Pichard, MD Director Cath Labs, Washington Hospital Center. ProfessorofMedicine (Cardiology), Georgetown University. Conflict of Interest Proctor
More information2/4/2019. Nursing Perspective of TAVR. Disclosure. Learning Outcomes
Nursing Perspective of TAVR Tara Whitmire, DNP, APRN-NP, NP-C, CHFN Nebraska Methodist Hospital Cardiothoracic Surgery Nurse Practitioner Danelle Homeyer, RN Methodist Physicians Clinic Director, Structural
More informationEdwards Sapien. Medtronic CoreValve. Inoperable FDA approved High risk: in trials. FDA approved
Transcatheter Aortic Valve Replacement Symptomatic Aortic Stenosis Asymptomatic Juan Crestanello, MD Interim Director, Division of Cardiac Surgery Associate Professor Division of Cardiac Surgery The Ohio
More informationTAVR for Complex Aortic Valvular Conditions
TAVR for Complex Aortic Valvular Conditions Wilson Y. Szeto, MD Professor of Surgery Chief, Cardiovascular Surgery at Penn Presbyterian Surgical Director, Transcatheter Cardio-Aortic Therapies Associate
More informationTreatment of Hypertrophic Cardiomyopathy in Bruce B. Reid, MD
Treatment of Hypertrophic Cardiomyopathy in 2017 Bruce B. Reid, MD Disclosures I have no conflicts of interest to disclose I will not be discussing any off label medications and/or devices Objectives 1)
More informationMITRAL (Mitral Implantation of TRAnscatheter valves)
MITRAL (Mitral Implantation of TRAnscatheter valves) 30-Day Outcomes of Transcatheter MV Replacement in Patients With Severe Mitral Valve Disease Secondary to Mitral Annular Calcification or Failed Annuloplasty
More informationAortic Valve Practice Guidelines: What Has Changed and What You Need to Know
Aortic Valve Practice Guidelines: What Has Changed and What You Need to Know James F. Burke, MD Program Director Cardiovascular Disease Fellowship Lankenau Medical Center Disclosure Dr. Burke has no conflicts
More informationPercutaneous Mitral Valve Repair: What Can We Treat and What Should We Treat
Percutaneous Mitral Valve Repair: What Can We Treat and What Should We Treat Innovative Procedures, Devices & State of the Art Care for Arrhythmias, Heart Failure & Structural Heart Disease October 8-10,
More informationFive-Year Outcomes of Transcatheter Aortic Valve Replacement (TAVR) in Inoperable Patients With Severe Aortic Stenosis: The PARTNER Trial
Five-Year Outcomes of Transcatheter Aortic Valve Replacement (TAVR) in Inoperable Patients With Severe Aortic Stenosis: The PARTNER Trial Samir R. Kapadia, MD On behalf of The PARTNER Trial Investigators
More informationWhat is Aortic Stenosis?
What is Aortic Stenosis? What is Aortic Stenosis? Very simply, aortic stenosis is a build-up of calcium deposits on the valve, which causes it to narrow and reduce blood flow to the rest of your body.
More informationAustralia and New Zealand Source Registry Edwards Sapien Aortic Valve 30 day Outcomes
Australia and New Zealand Source Registry Edwards Sapien Aortic Valve 30 day Outcomes A/ Professor Darren Walters On behalf of the ANZ Source Investigators Director of Cardiology Brisbane, Australia ANZ
More informationAortic Stenosis.
Aortic Stenosis www.cardiconcept.com Common causes Normal Rheumatic (Rim or Commissures) Calcific Degenerative Bicuspid Adapted from C. Otto, Principles of Echocardiography, 2007 Rare causes Congenital
More informationThe production of murmurs is due to 3 main factors:
Heart murmurs The production of murmurs is due to 3 main factors: high blood flow rate through normal or abnormal orifices forward flow through a narrowed or irregular orifice into a dilated vessel or
More informationOptions for my no option Patients Treating Heart Conditions Via a Tiny Catheter
Options for my no option Patients Treating Heart Conditions Via a Tiny Catheter Nirat Beohar, MD Associate Professor of Medicine Director Cardiac Catheterization Laboratory, Medical Director Structural
More informationHow Do I Evaluate a Patient Being Considered for TAVR? Sunday, February 14, :00 11:25 PM 25 min
2016 ASE State of the Art Echocardiography Course Tucson, AZ How Do I Evaluate a Patient Being Considered for TAVR? Sunday, February 14, 2016 11:00 11:25 PM 25 min 1 M U H A M E D S A R I Ć, M D, P H D
More informationDisclosures 4/16/2018. What s New in Valvularand Structural Heart Disease. None relevant to the presentation
What s New in Valvularand Structural Heart Disease Ryan C. Shelstad, MD Surgical Enthusiast, Valvular and Structural Heart Disease Bryan Heart Cardiothoracic Surgery Disclosures None relevant to the presentation
More information1-YEAR OUTCOMES FROM JOHN WEBB, MD
1-YEAR OUTCOMES FROM JOHN WEBB, MD ON BEHALF OF THE SAPIEN 3 INVESTIGATORS UNIVERSITY OF BRITISH COLUMBIA VANCOUVER, CANADA Potential conflicts of interest Speaker's name: John Webb I have the following
More informationEmbolic Protection Devices for Transcatheter Aortic Valve Replacement
Embolic Protection Devices for Transcatheter Aortic Valve Replacement James M. McCabe, MD Medical Director, Cardiac Cath Lab University of Washington Seattle, WA Disclosures Proctoring and honoraria for
More informationTranscatheter Heart Valve Therapy
Edwards Lifesciences 2017 Investor Conference Transcatheter Heart Valve Therapy Larry L. Wood Corporate Vice President, Transcatheter Heart Valves Leader in ~$3B Global Transcatheter Heart Valves Primary
More informationLOW RISK TAVR. WHAT THE FUTURE HOLDS
LOW RISK TAVR. WHAT THE FUTURE HOLDS Michael J. Reardon, M.D. Professor of Cardiothoracic Surgery Allison Family Distinguish Chair of Cardiovascular Research Houston Methodist DeBakey Heart & Vascular
More informationTSDA Boot Camp September 13-16, Introduction to Aortic Valve Surgery. George L. Hicks, Jr., MD
TSDA Boot Camp September 13-16, 2018 Introduction to Aortic Valve Surgery George L. Hicks, Jr., MD Aortic Valve Pathology and Treatment Valvular Aortic Stenosis in Adults Average Course (Post mortem data)
More informationAortic Stenosis Background and Breakthroughs in Treatment: TAVR Update
Aortic Stenosis Background and Breakthroughs in Treatment: TAVR Update Howard J Broder MD Interventional Cardiology DaVita Medical Group/ Healthcare Partners Cardiology Disclosures for Howard J Broder
More informationMedical Policy and and and and
ARBenefits Approval: 10/12/2011 Effective Date: 01/01/2012 Revision Date: Code(s): 93799, Unlisted cardiovascular service or procedure Medical Policy Title: Percutaneous Transluminal Septal Myocardial
More informationEssential Support for a Structural Heart Program: The Valve and Structural Heart Clinic
Essential Support for a Structural Heart Program: The Valve and Structural Heart Clinic Vincent Varghese, DO, FACC, FSCAI Director, Interventional Cardiology Fellowship Program Deborah Heart and Lung Center
More informationMinimalist Transcatheter Aortic Valve Replacement (MA-TAVR)
Minimalist Transcatheter Aortic Valve Replacement (MA-TAVR) Jensen HA, Condado JF, Devireddy C, Binongo JN, Leshnower BG, Babaliaros V, Sarin EL, Lerakis S, Guyton RA, Stewart JP, Syed AQ, Mavromatis K,
More informationIndication, Timing, Assessment and Update on TAVI
Indication, Timing, Assessment and Update on TAVI Swedish Heart and Vascular Institute Ming Zhang MD PhD Interventional Cardiology Structure Heart Disease Conflict of Interest None Starr- Edwards Mechanical
More informationLe TAVI pour tout le monde?
Le TAVI pour tout le monde? Thierry Lefèvre Institut Cardiovasculaire Paris Sud, Massy Disclosure Statement of Financial Interest I currently have, or have had over the last two years, an affiliation or
More informationTAVI PROGRAM CHANGING THE EDMONTON LANDSCAPE...
TAVI PROGRAM CHANGING THE EDMONTON LANDSCAPE... Benjamin Tyrrell MD, FRCPC Co-Director TAVI Program Northern Alberta CK HUI Heart Centre NOV 29, 2014 Disclosures None related to this talk Objectives Brief
More informationPARAVALVULAR LEAK POST TAVR. Elements of Follow-up Post TAVR
PARAVALVULAR LEAK POST TAVR David S Rubenson MD FACC FASE Founding Director, Cardiac Non-Invasive Laboratory Scripps Clinic Medical Group number 1 Elements of Follow-up Post TAVR JACC CV Imag 2016;9:193
More informationPercutaneous Mitral Valve Repair
Percutaneous Mitral Valve Repair MitraClip: Procedure, Data, Patient Selection Chad Rammohan, MD FACC Director, Cardiac Cath Lab El Camino Hospital Mountain View, California Mitral Regurgitation MitraClip
More informationTAVR: Intermediate Risk Patients
TAVR: Intermediate Risk Patients Oscar A. Mendiz.MD.FACC.FSCAI Director Cardiology & Cardiovascular Institute (ICyCC) Chief Interventional Cardiology Department Board of Directors Hospital & Favaloro University
More informationClinical and Echocardiographic Outcomes at 30 Days with the SAPIEN 3 TAVR System in Inoperable, High-Risk and Intermediate-Risk AS Patients
Clinical and Echocardiographic Outcomes at 30 Days with the SAPIEN 3 TAVR System in Inoperable, High-Risk and Intermediate-Risk AS Patients Susheel Kodali, MD on behalf of The PARTNER Trial Investigators
More informationWelcome 17 Michigan TAVR Participating Hospitals!
Welcome 17 Michigan TAVR Participating Hospitals! 1 MICHIGAN TAVR BRIEF OVERVIEW HOW AND WHY PRE-TAVR IMAGING EVALUATION AND THE TVT Michael Grossman, MD Co-Director, BMC2 Coordinating Center Why Michigan
More informationHardware in the Chest - From VADs to Valves
Hardware in the Chest - From VADs to Valves Cristina Fuss, MD Purpose Recognize the device Indication and function Cristina Fuss, MD Department of Diagnostic Radiology FROM VADS TO VALVES Implanting technique
More informationStrokes After TAVR. Ioannis Iakovou, MD, PhD. Interventional Cardiology Onassis Cardiac Surgery Center
Strokes After TAVR Ioannis Iakovou, MD, PhD Interventional Cardiology Onassis Cardiac Surgery Center Strokes After TAVR How common is stroke after TAVR Is it increasing? Is it more with TF vs TA? Is it
More informationCardiac Valve/Structural Therapies
Property of Dr. Chad Rammohan Cardiac Valve/Structural Therapies Chad Rammohan, MD FACC Medical Director, El Camino Hospital Cardiac Catheterization Lab Director, Interventional and Structural Cardiology,
More informationValve Replacement without a Scalpel Transcatheter Aortic Valve Replacement (TAVR) Charles T. Klodell, M.D.
Valve Replacement without a Scalpel Transcatheter Aortic Valve Replacement (TAVR) Charles T. Klodell, M.D. Professor, Thoracic and Cardiovascular Surgery University of Florida klodell@surgery.ufl.edu Disclosures
More informationValvular Guidelines: The Past, the Present, the Future
Valvular Guidelines: The Past, the Present, the Future Robert O. Bonow, MD, MS Northwestern University Feinberg School of Medicine Bluhm Cardiovascular Institute Northwestern Memorial Hospital Editor-in-Chief,
More informationThe Future of TAVR: Minimalist Fast Track
The Future of TAVR: Minimalist Fast Track Zvonimir Krajcer, MD Program Director- Peripheral Vascular Interventions Department of Cardiology, St. Luke s Episcopal Hospital and Texas Heart Institute, Houston,
More informationIndicator Mild Moderate Severe
Indicator Mild Moderate Severe Jet velocity (m/s) 2.0-2.9 3.0-3.9 4.0 Mean gradient (mmhg) < 20 20-39 40 Valve area (cm 2 ) 1.0 Valve area index (cm 2 /m 2 ) 0.6 1 Abnormal AV with Reduced Systolic Opening
More informationWhat is TAVR? Transcatheter Aortic Valve Replacement
What is TAVR? Transcatheter Aortic Valve Replacement What Are Your Options for Treating Severe Aortic Stenosis? Treatment for aortic stenosis depends on how far your disease has progressed. If your stenosis
More informationTRANSAPICAL AORTIC VALVE REPAIR
TRANSAPICAL AORTIC VALVE REPAIR Mauro ROMANO M.D. Department of Cardio-Vascular Surgery Institut Cardiovasculaire Paris Sud Institut Hospitalier Jacques Cartier MASSY FRANCE romano.mauro@orange.fr Treatment
More informationNON SURGICAL TREATMENT OF CARDIAC DISEASE PETER J SABIA, MD FACC ASSOCIATES IN CARDIOLOGY SILVER SPRING, MARYLAND
NON SURGICAL TREATMENT OF CARDIAC DISEASE PETER J SABIA, MD FACC ASSOCIATES IN CARDIOLOGY SILVER SPRING, MARYLAND TOPICS ATRIAL SEPTAL DEFECT VSD IHSS PERCUTANEOUS AORTIC VALVE PERCUTANEOUS MITRAL VALVE
More informationIndex. interventional.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Ablation, of mitral leaflets, 80 Accucinch Annuloplasty system, for mitral regurgitation, 79, 94 95 Accutrak delivery system, for CoreValve
More informationThe Changing Epidemiology of Valvular Heart Disease: Implications for Interventional Treatment Alternatives. Martin B. Leon, MD
The Changing Epidemiology of Valvular Heart Disease: Implications for Interventional Treatment Alternatives Martin B. Leon, MD Columbia University Medical Center Cardiovascular Research Foundation New
More informationWorldwide rheumatic fever is the most common cause of valve disease. In industrialized areas, valvular disease of old age predominates
Michael Sumners DO Epidemiology Worldwide rheumatic fever is the most common cause of valve disease In industrialized areas, valvular disease of old age predominates Calcific aortic stenosis Functional
More information