Transcatheter Aortic Valve Implantation. SSVQ November 23, 2012 Centre Mont-Royal 15:40
|
|
|
- Ada Harper
- 5 years ago
- Views:
Transcription
1 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
2
3 First-in-Human Cribier-Edwards Cribier et al. Circulation 2002;106:
4 Dr. Jean-Claude Laborde 1 st generation CoreValve
5 January November
6
7 Carotid artery Ascending aorta Subclavian artery Left ventricular apex Femoral artery
8
9 Austria Belgium Denmark France Germany Italy Netherlands Portugal Spain Switzerland United Kingdom
10 Registry data
11
12 35 TAVI implants/million
13 Registry data
14 53 TAVI centers/country
15 Approximately 1 TAVI center/million
16 51 TAVI implants/ center
17 Mechanical SAVR Biological SAVR
18 Mechanical SAVR Biological SAVR TAVI
19 Mechanical SAVR Biological SAVR TAVI
20 Crossing of fortunes
21 Mechanical SAVR Biological SAVR TAVI Total numbers
22 TAVI SAVR % mortality
23 STS database % 66% Extreme risk/inoperable (STS >15%) High risk (STS > 10-15%) Intermediate risk (STS 4-10%) Low risk (STS <4%)
24 June 2007 June st 2nd 3rd 4th N=105 N=105 N=105 N=105 n = 420 patients Change in baseline characteristics Impact on 30-day and 6-month mortality
25 Q1 Q2 Q3 Q4 Age (yrs.) Logistic ES (%) STS (%)
26 11.4% Q1 4-fold reduction 3.8% Q4 Lange et al. JACC 2012
27 23.5% Q1 2-fold reduction Q4 12.4% Lange et al. JACC 2012
28 TAVI vs. SAVR Intermediate Risk Foundation for the SURTAVI trial Manuscript in submission
29 3666 patients enrolled TAVI 782 SAVR matched patients TAVI 392 SAVR matched patients (STS scores 3-8%) 2882 patients excluded based on propensity scores 274 patients excluded based on STS score <3% and >8% TAVI 255 patients analyzed SAVR 255 patients analyzed
30 Bern-Rotterdam-Munich Study
31 1-year Mortality (STS 3-8%) Bern-Rotterdam-Munich Study
32 CoreValve SURTAVI Trial Study Design
33 Symptomatic Severe Aortic Stenosis ASSESSMENT by Heart Valve Team n=2000 Randomized Patients Yes Operable (STS 4) ASSESSMENT: Transfemoral Access No Two Parallel Randomized Trials +3 Nested Registries Inoperable ASSESSMENT: Transfemoral Access n=500 Randomized Patients Transfemoral (TF) Transapical (TA) Yes >7mm Yes 6-7mm No 1:1 Randomization 1:1 Randomization 1:1 Randomization 6-7mm Registry TF TAVR SAPIEN XT VS Surgical AVR TAVR: TA / TAO VS Surgical AVR TF TAVR SAPIEN XT VS TF TAVR SAPIEN TA Registry TAO Registry Primary Endpoint: All-Cause Mortality + Major Stroke at Two Years (Non-inferiority) Primary Endpoint: All-Cause Mortality + Major Stroke + Repeat Hospitalization at One Year (Non-inferiority) Transcatheter Valve-in-Surgical Valve Registry
34 Patient characteristics Access route Valve type and size
35 Echocardiography Coronary angiography CT imaging
36 Function Anchoring Sealing
37 Annular rupture Coronary obstruction Embolization Paravalvular leaks Conduction abnormalities Patient-prosthesis mismatch
38
39 Perimeter Area Diameters
40 Prosthesis dimension Annulus dimension Annulus dimension X 100 Prosthesis dimension = annulus perimeter
41
42 Edwards SAPIEN - PARTNER 1 RCT - PARTNER Continued Access Program - Source and Source XT registry Medtronic CoreValve - Advance Registry - National Registries
43 Stainless Steel Frame Bovine Pericardial Cribier-Edwards THV 23mm Edwards SAPIEN THV 23 mm and 26 mm Edwards SAPIEN XT THV 23 mm, 26 mm, and 29mm
44 PARTNER Trial Timelines May 07 Aug 09 Mar 09 Aug 09 Mar 11 Dec 11 PARTNER IB - TF Randomized continued access Cohort B - TF PARTNER IA - TF PARTNER IA - TA Transapical approach not available at start of PARTNER I Trial PARTNER continued access TA and TF PARTNER IIB - TF PARTNER IIA
45 Symptomatic Severe Aortic Stenosis ASSESSMENT: High-Risk AVR Candidate 3,105 Total Patients Screened N = 699 High Risk Total = 1,057 patients 2 Parallel Trials: Individually Powered Inoperable N = 358 ASSESSMENT: Transfemoral Access Yes No 1:1 Randomization Not In Study N = 179 TF TAVR VS N = 179 Standard Therapy Primary Endpoint: All-Cause Mortality Over Length of Trial (Superiority) Co-Primary Endpoint: Composite of All-Cause Mortality and Repeat Hospitalization (Superiority)
46 Standard Rx TAVR HR [95% CI] = 0.53 [0.41, 0.68] p (log rank) < % All Cause Mortality (%) 50.8% 20.1% 30.7% NNT = 5.0 pts 68.0% 25.0% 43.0% NNT = 4.0 pts 54.1% 26.8% NNT = 3.7 pts Months
47 STS <5 STS STS 15 Cohort C Futile 100% 100% Death Incidence (%) 80% 60% 40% 20% p value (log rank) = % 60% 40% 20% p value (log rank) = % Months 0% Months 47
48 Symptomatic Severe Aortic Stenosis ASSESSMENT: High-Risk AVR Candidate 3,105 Total Patients Screened N = 699 High Risk Total = 1,057 patients 2 Parallel Trials: Individually Powered Inoperable N = 358 Yes ASSESSMENT: Transfemoral Access No ASSESSMENT: Transfemoral Access Transfemoral (TF) Transapical (TA) Yes No 1:1 Randomization 1:1 Randomization 1:1 Randomization Not In Study N = 244 N = 248 N = 104 N = 103 N = 179 N = 179 TF TAVR VS AVR TA TAVR VS AVR TF TAVR VS Standard Therapy Primary Endpoint: All-Cause Mortality at 1 yr (Non-inferiority) Primary Endpoint: All-Cause Mortality Over Length of Trial (Superiority) Co-Primary Endpoint: Composite of All-Cause Mortality and Repeat Hospitalization (Superiority)
49 49
50
51 Goal of the registry was to allow investigators to maintain proficiency with the procedure and to continue to gather data - Over 2000 patients were enrolled between completion of the PARTNER trial in Aug 09 and initiation of the PARTNER IIA trial in Dec 11 All patients were treated with the Edwards Sapien valve from either the transapical or transfemoral approach depending on access Retroflex 3 catheter was used for all transfemoral cases Enrollment was limited by the FDA (39 patients/month initially) This allowed for 1-2 cases per site per month
52 PARTNER RCT n = 1057 PARTNER NRCA n = 2068 Cohort A TF Arm Cohort A TA Arm Cohort B TF Transfemoral n=1080 Transapical n = 988 TA TAVR (n=104) SAVR (n=103) NRCA TF n = 1080 TF TAVR (n=244) SAVR (n=248) TF TAVR (n=179) Medical (n=179) PMA TF n = 423
53 Characteristic PMA Cohort TF-TAVR (n=423) NRCA Cohort TF-TAVR (n=1080) p-value Age yr ± ± 7.75 <0.001 STS Score ± ± Logistic EuroSCORE ± ± <0.001 NYHA Class III - % Class IV - % CAD - % Previous MI - % Prior PCI - % Prior CABG - % Prior BAV - % < Cerebrovascular Disease - % Peripheral Vascular Disease - %
54 Surgical Cutdown - % < Total procedure time (skin-to-skin) (min) ± ± < Post-Dilatation <0.0001
55 All mortality no. (%) 24 (5.7) 53 (4.9) 0.54 Cardiac mortality no. (%) 18 (4.3) 36 (3.3) 0.39 Rehospitalization no. (%) 23 (5.4) 63 (5.8) 0.77 Death or rehosp no. (%) 44 (10.4) 114 (10.6) 0.93 Stroke or TIA no. (%) 26 (6.1) 41 (3.8) 0.05 Stroke 23 (5.4) 36 (3.3) 0.06
56 All mortality % Cardiac mortality % Stroke % Death or major stroke - %
57 PARTNER 1 RCT vs. NRCA All-cause mortality TF-TAVR 2-Yr Death (%) PMA NRCA HR: 1.31 [95% CI: 1.07, 1.62] Log-Rank p= % 29.5% Time in Months Number at risk PMA NRCA * Events adjudicated to one year
58
59 Registry Enrollment Time Cohort 1 N=1038 SOURCE Cohort 2 N=1269 SOURCE XT N=2681 Nov 07- Jan 09 Feb 09 Dec 09 Dec 10 Jun 11 THV SAPIEN SAPIEN XT TF Delivery System TA Delivery System Retroflex Novaflex Ascendra Ascendra 2
60 THV SAPIEN SAPEIN XT Centers Countries Access TF, TA TF, TA, TAO, SC THV SAPIEN 23mm, 26mm SAPIEN XT 23mm, 26mm, 29mm AE Definitions Non VARC VARC AE Adjudication Principal Investigators CEC Monitoring No Yes Follow-up 30 Days, annually to 2 Years 30 Days, annually to 5 Years
61
62 SOURCE Cohort 1 Cohort 2 SOURCE XT Nov 07- Jan 09 Feb 09 Dec 09 Jul 10 Oct 11 TF RetroFlex NovaFlex NovaFlex+ esheath 22/24 Fr. 18/19Fr 16/18Fr Ascendra Ascendra 2 TA 33/26 Fr 24/24 Fr
63
64 SOURCE SOURCE XT 3.7% 0.3% 62.7% 39.9% 33.3% 62.7% TF TA TAO Subclavian
65
66
67 All-cause Mortality (%) < Cardiac mortality (%) Any Stroke (%) < Vascular Complication Major (%)* < Major Bleeding (%) * < Ventricular Injury (%) MI (%) New pacemaker * Different definitions for SOURCE and SOURCE XT
68 Major Bleeding Major Vascular Complications (%) (%) P= P=0.0003
69 CoreValve ADVANCE Methods
70 CoreValve ADVANCE Baseline Characteristics
71 CoreValve ADVANCE Procedural Results
72 CoreValve ADVANCE 30-day Outcomes
73 CoreValve ADVANCE 6-month Survival
74 CoreValve ADVANCE 6-month Stroke
75 Paravalvular aortic regurgitation Stroke Conduction disturbances
76 PARTNER 1A ADVANCE Registry Mild AR associated with mortality? Moderate AR associated with mortality?
77 PARTNER 1 NRCA Only Mortality & Paravalvular leak 2-Year Death (%) NRCA-TF - None or Trace PVL at 30D NRCA-TF - Mild PVL at 30D NRCA-TF - Mod or Sev PVL at 30D 37.8% 21.7% 20.2% 10 Log Rank P= < Time in Days Number At Risk None or Trace PVL Mild PVL Mod or Sev PVL * Events adjudicated to one year
78 PARTNER 1 RCT TAVR vs. AVR 2-year Stroke p=0.12
![PARTNER 1 RCT vs. NRCA 2-year Stroke TF-TAVR 2-Yr Stroke (%) 10 8 6 4 2 0 PMA NRCA HR: 1.58 [95% CI: 1.03, 2.43] Log-Rank p= 0.036 9.0% 5.](/docs-images/83/88538615/images/79-0.jpg "8% 0 4 8 12 16 20 24 Time in Months Number at risk PMA NRCA 423 349 321 299 279 267 254 1080 916 743 580 292 264 177 * Events adjudicated to")
79 PARTNER 1 RCT vs. NRCA 2-year Stroke TF-TAVR 2-Yr Stroke (%) PMA NRCA HR: 1.58 [95% CI: 1.03, 2.43] Log-Rank p= % 5.8% Time in Months Number at risk PMA NRCA * Events adjudicated to one year
80 CoreValve ADVANCE Freedom from Stroke
81 CoreValve National Registries Stroke 30-days
82
83 ADVANCE Registry Italian Registry No association between new-onset LBBB and mortality at 6-months, 1, and 2 years Urena et al. J Am Coll Cardiol 2012
84 CoreValve National Registries Pacemaker Implantation
85 CoreValve Advance Registry Impact of PPM
86 Introduction of new devices: head to head randomized trials or registries? Phase 1 Phase 2 Phase 3 Setting with no other US legally marketed transcatheter valve RCT TAVI vs. SAVR TAVI vs. medical treatment After transcatheter valve is on the US market for the same indications being sought RCT TAVI old vs. TAVI new Significant long-term data about transcatheter valves is available OPC can be developed Registry Single arm clinical trial
87 TAVI CANDIDATES 2012 Low Risk Intermediate Risk High Risk Inoperable SAVR PATIENTS? PARTNER II SURTAVI TAVI POPULATION
Incorporating 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
TAVR 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
Results of Transfemoral Transcatheter Aortic Valve Implantation
Results of Transfemoral Transcatheter Aortic Valve Implantation Saudi Heart Association, February 21-24 Rüdiger Lange, MD, PhD Nicolo Piazza, MD, FRCPC, FESC German Heart Center, Munich, Germany Division
RANDOMISED TRIALS TAVI WITH SAVR STEPHAN WINDECKER AORTIC VALVE DISEASE COMPARING
AORTIC VALVE DISEASE RANDOMISED TRIALS COMPARING TAVI WITH SAVR STEPHAN WINDECKER DEPARTMENT OF CARDIOLOGY SWISS CARDIOVASCULAR CENTER AND CLINICAL TRIALS UNIT BERN BERN UNIVERSITY HOSPITAL, SWITZERLAND
1-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
An 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,
Transcatheter 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
CIPG 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
TAVR-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
Transcatheter 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,
Neal Kleiman, MD Houston Methodist DeBakey Heart and Vascular Institute
Neal Kleiman, MD Houston Methodist DeBakey Heart and Vascular Institute Despite a 33 fold growth in the first five years, there is still tremendous variability among penetration in different countries
TAVI: 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
TAVR 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
Aortic 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
2/28/2010. Speakers s name: Paul Chiam. I have the following potential conflicts of interest to report: NONE. Antegrade transvenous transseptal route
Transcatheter Aortic Valve Implantation Asian perspective Speakers s name: Paul Chiam Paul TL Chiam MBBS, MRCP, FACC I have the following potential conflicts of interest to report: NONE Consultant National
Edwards Lifesciences 2011 Investor Conference 12/9/2011
Edwards Lifesciences 2011 Investor Conference EDWARDS LIFESCIENCES Transcatheter Heart Valves Larry L. Wood Corporate Vice President, Transcatheter Valve Replacement 2 1 Edwards Lifesciences 2011 Investor
Igor 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
Update 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
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
Transcatheter 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
Is TAVI ready for prime time in: - Intermediate risk patients? - Low risk patients?
Is TAVI ready for prime time in: - Intermediate risk patients? - Low risk patients? Didier TCHETCHE, MD. Clinique PASTEUR, Toulouse, France, Conflicts of interest: -Consultant for Edwards LifeSciences
TAVI: Nouveaux Horizons
TAVI: Nouveaux Horizons EUAPI580i 432HQ14NP02353 Institut de Cardiologie de la Pitié-Salpêtrière jean-philippe.collet@psl.aphp.fr www.action-coeur.org Objectifs Les recommandations Le TAVI en chiffre La
A 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
LOW 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
TAVR for low-risk patients in 2017: not so fast.
TAVR for low-risk patients in 2017: not so fast. Enrico Ferrari, MD, FETCS Cardiac Surgery Department Cardiocentro Ticino Foundation Lugano, Switzerland Conflicts of Interest Consultant and proctor for
Le 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
TAVI in Korea, How to Avoid Conduction
TAVI in Korea, How to Avoid Conduction Disturbance after CoreValve Seung-Jung Park, MD, PhD Professor of Medicine, University of Ulsan College of Medicine, Heart Institute, Asan Medical Center, Seoul,
Percutaneous Aortic Valve Implantation. Core-Valve and Cribier-Edwards Update
Percutaneous Aortic Valve Implantation. Core-Valve and Cribier-Edwards Update T. Lefèvre Natural History of Aortic Stenosois 100 Latent period Survival (%) 80 60 40 20 Symptoms Average Age Death 0 40 50
Edwards 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
TAVR: 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
The Role of TAVI in high-risk and normal-risk Patients
The Role of TAVI in high-risk and normal-risk Patients Joachim Schofer Hamburg University Cardiovascular Center and Department for percutaneous treatment of structural heart disease Albertinen Heart Center
TAVR 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
SAPIEN 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
Aortic 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
TAVI 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
3 years after introduction of TAVI in QEH. Michael KY Lee On Behalf of QEH TAVI Heart Team Queen Elizabeth Hospital Hong Kong
3 years after introduction of TAVI in QEH Michael KY Lee On Behalf of QEH TAVI Heart Team Queen Elizabeth Hospital Hong Kong HA Convention 2014 Introduction Aortic Stenosis most common valvular heart disease
Edwards 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
Transcatheter 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
Disclosures 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
Transcatheter Aortic Valve Implantation (TAVI) - 5 important lessons learnt from HK experiences Michael KY Lee
Transcatheter Aortic Valve Implantation (TAVI) - 5 important lessons learnt from HK experiences Michael KY Lee Queen Elizabeth Hospital, Hong Kong President, HKSTENT APCASH 2013 SJ Park TAVI Summit 2013
Is 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
Five-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
TAVR 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
TAVI: 10 Years After the First Case Low-Risk and High-Risk Patients What are the Limits? Dr Bernard Prendergast DM FRCP FESC John Radcliffe Hospital
TAVI: 10 Years After the First Case Low-Risk and High-Risk Patients What are the Limits? Dr Bernard Prendergast DM FRCP FESC John Radcliffe Hospital Oxford I have financial relationships to disclose Honoraria
TAVI- 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
2/15/2018 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
Current Evidence in TAVI patients using ACURATE and LOTUS valves
Current Evidence in TAVI patients using ACURATE and LOTUS valves Giuseppe Tarantini, MD, PhD, FESC, Professor and Director of Interventional Cardiology University of Padua GISE President Potential conflicts
Prosthesis-Patient Mismatch in High Risk Patients with Severe Aortic Stenosis in a Randomized Trial of a Self-Expanding Prosthesis
Prosthesis-Patient Mismatch in High Risk Patients with Severe Aortic Stenosis in a Randomized Trial of a Self-Expanding Prosthesis George L. Zorn, III On Behalf of the CoreValve US Clinical Investigators
TAVI: Transapical Procedures
Cardiology Update Davos TAVI: Transapical Procedures Volkmar Falk, MD University Hospital Zürich TA-AVI: antegrade, simple, safe The front door approach! Transapical TAVI Technical advantages of TA approach
Australia 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
THE 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
Transcatheter Aortic Valve Replacement with a Self-Expanding Prosthesis or Surgical Aortic Valve Replacement in Intermediate-Risk Patients:
Transcatheter Aortic Valve Replacement with a Self-Expanding Prosthesis or Surgical Aortic Valve Replacement in Intermediate-Risk Patients: 1-Year Results from the SURTAVI Clinical Trial Nicolas M. Van
TAVI 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
Indication, 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
Debate: SAVR for Low-Risk Patients in 2017 is Obsolete AVR vs TAVI
Debate: SAVR for Low-Risk Patients in 2017 is Obsolete AVR vs TAVI Joseph E. Bavaria, MD Roberts-Measey Professor of Surgery Vice Chair, Division of Cardiovascular Surgery University of Pennsylvania Immediate
The Future of Medicine. Who to TAVR? Azeem Latib MD EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy
The Future of Medicine Who to TAVR? Azeem Latib MD EMO-GVM Centro Cuore Columbus and San Raffaele Scientific Institute, Milan, Italy FIRST PATIENT TO UNDERGO PTCA FIRST PATIENT TO UNDERGO TAVI Grüntzig
TAVI: Present and Future Perspective
TAVI: Present and Future Perspective Igor F. Palacios, M.D. Director of Interventional Cardiology Massachusetts General Hospital Professor of Medicine Harvard Medical School Percutaneous transcatheter
Outcome of Next-Generation Transcatheter Valves in Small Aortic Annuli: A Multicenter Propensity-Matched Comparison
Outcome of Next-Generation Transcatheter Valves in Small Aortic Annuli: A Multicenter Propensity-Matched Comparison Mauri, V. et al.: Circ Cardiovasc Interv. 2017;10:e005013 All trademarks are the property
Appropriate Use of TAVR - now and in the future. A Surgeon s Perspective. Neil Moat Royal Brompton Hospital, London, UK
Appropriate Use of TAVR - now and in the future A Surgeon s Perspective Neil Moat Royal Brompton Hospital, London, UK Disclosure Statement of Financial Interest Within the past 12 months, I or my spouse/partner
Results of Transapical Valves. A.P. Kappetein Dept Cardio-thoracic surgery
Results of Transapical Valves A.P. Kappetein Dept Cardio-thoracic surgery Rotterda am, The Netherlands 2002 FIM 2003 2005 2006 2010 THV THV Cribier-Edwards Edwards Edwards Sapien Sapien XT Bovine pericardium
ΔΙΑΔΕΡΜΙΚΗ ΑΝΣΙΚΑΣΑΣΑΗ ΑΟΡΣΙΚΗ ΒΑΛΒΙΔΑ αντιμετώπιση επιπλοκών ΠΕΣΡΟ. ΔΑΡΔΑ, MD, FESC IICE 2012
ΔΙΑΔΕΡΜΙΚΗ ΑΝΣΙΚΑΣΑΣΑΗ ΑΟΡΣΙΚΗ ΒΑΛΒΙΔΑ αντιμετώπιση επιπλοκών ΠΕΣΡΟ. ΔΑΡΔΑ, MD, FESC IICE 2012 TAVR Technologies Current Generation Devices ~ 50,000 patients treated thru 2011 in > 500 interventional centers
After 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
Aortic Stenosis: Background
Transcatheter Aortic Valve Replacement in Low Surgical Risk Patients Barry George, MD The Ohio State University Structural Heart Disease Course May 19 th, 2017 Aortic Stenosis: Background Severe Symptomatic
Severe Aortic Valve Disease: TAVR in Four Ages and Four Etiologies Age 25 y/o Congenital, 50 y/o Bicuspid, 75 y/o Rheumatic, 100 y/o Degenerative
Severe Aortic Valve Disease: TAVR in Four Ages and Four Etiologies Age 25 y/o Congenital, 50 y/o Bicuspid, 75 y/o Rheumatic, 100 y/o Degenerative Samin K. Sharma, MD, FACC, FSCAI Director Clinical & Interventional
Valve 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
TAVI limitations for low risk patients
TAVI limitations for low risk patients Dr. T. Modine / P. Lancellotti MD, PhD, MBA CHRU de Lille, France Potential conflicts of interest Speaker's name: Thomas Modine I have the following potential conflicts
Aortic valve implantation using the femoral and apical access: a single center experience.
Aortic valve implantation using the femoral and apical access: a single center experience. R. Hoffmann, K. Brehmer, R. Koos, R. Autschbach, N. Marx, G. Dohmen Rainer Hoffmann, University Aachen, Germany
Prince Sultan Cardiac Center Experience Riyadh, Saudi Arabia
Transcatheter Transapical Aortic Valve Implantation Prince Sultan Cardiac Center Experience Riyadh, Saudi Arabia Ahmed Elwatidy, MD,PhD, FRCS S Kassab, MD,S Ahmari, MD, H Amri, MD, H Ismail, MD, A Calafiori,
Trans 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
Aortic stenosis (AS) remains the most common
Sapien Valve: Past, Present, and Future A look at how the Sapien family of valves continues to evolve to treat a range of patients seeking transcatheter aortic valve replacement. BY RAVINDER SINGH RAO,
Eberhard Grube, MD, FACC, FSCAI
TCT Asia Seoul, April 29, 2010 MDT / Core Valve Device Evolution, Technique and Clinical Trial Update Eberhard Grube, MD, FACC, FSCAI Intl. Heart Center Rhein-Ruhr, Essen, Germany Hospital Oswaldo Cruz
Transcatheter Aortic Valve Replacement with Evolut-R
Transcatheter Aortic Valve Replacement with Evolut-R Department of Transcatheter Heart Valves and 2 nd Cardiothoracic Surgery Clinic K. Spargias, M.Chrissoheris, A.Halapas, I. Nikolaou, S.Pattakos Disclosures
Stainless Steel. Cobalt-chromium
Sapien is better than Corevalve! Raj R. Makkar, MD Associate Director, Cedars-Sinai Heart Institute Associate Professor, UCLA School of Medicine, Los Angeles Eberhard Grube: Pioneer in the field of TAVR
Aortic 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
Evolving 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
Valvular Intervention
Valvular Intervention Outline Introduction Aortic Stenosis Mitral Regurgitation Conclusion Calcific Aortic Stenosis Deformed Eccentric Calcified Nodular Rigid HOSTILE TARGET difficult to displace prone
Percutaneous Treatment of Valvular Heart Diseases: Lessons and Perspectives. Bernard Iung Bichat Hospital, Paris
Percutaneous Treatment of Valvular Heart Diseases: Lessons and Perspectives Bernard Iung Bichat Hospital, Paris Euro Heart Survey on Valvular Diseases 3547 Patients with Native Valve Disease n= 1250 1000
Paravalvular Regurgitation is a Risk Factor Following TAVI
Paravalvular Regurgitation is a Risk Factor Following TAVI Philippe Pibarot, DVM, PhD, FACC, FESC, FASE Canada Research Chair in Valvular Heart Disease INSTITUT UNIVERSITAIRE DE CARDIOLOGIE ET DE PNEUMOLOGIE
TAVR 2018: TAVR has high clinical efficacy according to baseline patient risk! ii. Con
TAVR 2018: TAVR has high clinical efficacy according to baseline patient risk! ii. Con Dimitrios C. Angouras, MD, FETCS Associate Professor of Cardiac Surgery National and Kapodistrian University of Athens,
Andrzej Ochala, MD Medical University of Silesia, Katowice, Poland
Andrzej Ochala, MD Medical University of Silesia, Katowice, Poland Bicuspid aortic valve o Most common congenital heart disease in adults (1% - 2%) o AS is the most common complication of BAV o Patophysiology
Peri-operative results and complications in 15,964 transcatheter aortic valve implantations from the German Aortic valve RegistrY (GARY)
Peri-operative results and complications in 15,964 transcatheter aortic valve implantations from the German Aortic valve RegistrY (GARY) Thomas Walther, Christian W. Hamm, Gerhard Schuler, Alexander Berkowitsch,
30-Day Outcomes Following Implantation of a Repositionable Self-Expanding Aortic Bioprosthesis: First Report From the FORWARD Study
30-Day Outcomes Following Implantation of a Repositionable Self-Expanding Aortic Bioprosthesis: First Report From the Study Stephan Windecker Department of Cardiology Bern University Hospital - INSELSPITAL
Transcatheter Aortic Valve Implantation Present Status and Perspectives
Transcatheter Aortic Valve Implantation Present Status and Perspectives Angioplasty Summit TCTAP 2010 Alain Cribier, MD University of Rouen, France Transcatheter Aortic Valve Implantation has entered the
TAVR: Review of the Robust Data from Randomized Trials
TAVR: Review of the Robust Data from Randomized Trials Nicholas J. Ruggiero II, MD,FACP, FACC, FSCAI, FSVM, FCPP Director, Structural Heart Disease and Non-Coronary Interventions Director, Jefferson Heart
Complicanze durante TAVI. Brambilla Nedy IRCCS Policlinico San Donato
Complicanze durante TAVI Brambilla Nedy IRCCS Policlinico San Donato 0 2 4 6 9 11 14 16 22 26 31 33 37 43 52 61 69 78 87 93 106 113 121 151 171 186 201 225 267 283 294 311 349 502 515 709 1007 Number of
Disclosures. During the past 12 months, I have received research grants, advisory boards, consultation fees/honoraria, and/or travel expenses from:
Update on Transcatheter Aortic Valve Replacement Vinod H. Thourani, MD Associate Professor of Cardiothoracic Surgery Associate Director, Structural Heart Center Associate Director, CTS Clinical Research
Structural 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
Istanbul Course of Interventional Cardiology Istanbul, June 11, 2011
Istanbul Course of Interventional Cardiology Istanbul, June 11, 2011 Within the past 12 months, the presenter or their spouse/partner have had a financial interest/arrangement or affiliation with the organization(s)
PARTNER 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*
Strokes After TAVR Reasons for Declining Frequency
Strokes After TAVR Reasons for Declining Frequency Samir Kapadia, MD Professor of Medicine Director, Cardiac Catheterization Laboratory Cleveland Clinic Disclosure NONE Second Generation Valves Newer
Vinod H. Thourani, MD, FACC, FACS
Considering SAVR in the TAVR era: Surgical Implications of TAVR Vinod H. Thourani, MD, FACC, FACS Professor of Cardiothoracic Surgery and Medicine Chief of Cardiothoracic Surgery, Emory Hospital Midtown
Valvular 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
Transcatheter aortic valve implantation for severe aortic valve stenosis with the ACURATE neo2 valve system: 30-day safety and performance outcomes
All cited trademarks are the property of their respective owners. CAUTION: The law restricts these devices to sale by or on the order of a physician. Indications, contraindications, warnings and instructions
Transcatheter Aortic Valve Implantation (TAVI)
Transcatheter Aortic Valve Implantation (TAVI) QEH Registry A Multidisciplinary Team Approach Michael KY Lee 1, LK Chan 1, KC Chan 1, KT Chan 1, SF Chui 1, HS Ma 1, CY Wong 1, CS Chiang 1, P Li 1, CB Lam
TAVR 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
TAVI Technology and Procedural Changes
TCT AP 2013 Seoul, South Korea April, 2013 TAVI Technology and Procedural Changes Eberhard Grube MD, FACC, FSCAI University Hospital, Dept of Medicine II, Bonn, Germany Hospital Alemão Oswaldo Cruz, São
Clinical 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
Strokes 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
Valve Disease in Patients With Heart Failure TAVI or Surgery? Miguel Sousa Uva Hospital Cruz Vermelha Lisbon, Portugal
Valve Disease in Patients With Heart Failure TAVI or Surgery? Miguel Sousa Uva Hospital Cruz Vermelha Lisbon, Portugal I have nothing to disclose. Wide Spectrum Stable vs Decompensated NYHA II IV? Ejection
Transcatheter Aortic-Valve Implantation for Aortic Stenosis
Transcatheter Aortic-Valve Implantation for Aortic Stenosis Policy Number: 7.01.132 Last Review: 6/2018 Origination: 2/2012 Next Review: 2/2019 Policy Blue Cross and Blue Shield of Kansas City (Blue KC)