Rapid deployment aortic valve replacement for the treatment of severe aortic stenosis in high risk patients. Β. Κόλλιας, Σ. Ματιάτου, Δ. Αγγουράς.
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1 Rapid deployment aortic valve replacement for the treatment of severe aortic stenosis in high risk patients. Οι βιοπροσθετικές αορτικές βαλβίδες ταχείας έκπτυξης στην αντιµετώπιση της σοβαρής αορτικής στένωσης σε ασθενείς υψηλού χειρουργικού κινδύνου: παρουσίαση της πρώτης σειράς ασθενών στην Ελλάδα. Β. Κόλλιας, Σ. Ματιάτου, Δ. Αγγουράς. Βασίλειος Κόλλιας Πανεπιστηµιακή Καρδιοχειρουργική Κλινική Attikon University Hospital - Department of Cardiac Surgery
2 Management of severe AV stenosis in high risk patients Trans-catheter aortic valve implantation (TAVI) Surgical aortic valve replacement (savr) Rapid Deployment Aortic Valve Replacement (RD-AVR) Attikon University Hospital - Department of Cardiac Surgery
3 Hybrid bioprosthetic valves Sutureless AVR Perceval - S (Sorin, Italy) Rapid deployment AVR Edwards Intuity Elite (Edwards, USA). Attikon 2013 Attikon 2015 Attikon University Hospital - Department of Cardiac Surgery
4 Rapid deployment AVR Attikon University Hospital - Department of Cardiac Surgery
5 Surgical AVR + TAVI RD - AVR Attikon University Hospital - Department of Cardiac Surgery
6 Patients & methods Inclusion criteria (Heart Team): Rejected TAVI (logistic Euroscore >20% - coexisting severe CAD or valve disease) Selected medium - high risk patients (logistic Euroscore 10-20% or STS score > 4) with: Heavily calcified or porcelain aorta Severe COPD requiring O 2 Obesity small aortic annulus Chest radiation Exclusion criteria: low risk & young pts (<65yo) Attikon University Hospital - Department of Cardiothoracic Surgery
7 Results RDAVR in 17 patients (10 female) Age: 78.5±5.6 yo STS score 6.4±3.3 Logistic Euroscore 18.5±7.1% NYHA class: 3.3±0.7 Peak gradient (pre-op): 85.9±22.9 mmhg Mean gradient (pre-op): 46.3±18.9 mmhg AVA: 0.59±0.1cm 2. Attikon University Hospital - Department of Cardiac Surgery
8 Results Rejected TAVI (logistic Euroscore >20% - coexisting severe CAD or valve disease) Heavily calcified or porcelain aorta Severe COPD - requiring O2 Obesity small aortic annulus Chest radiation immunosuppressive therapy Chronic kidney disease (CKD stage 3-5) Peripheral vascular disease (PVD) History of cancer (liver, breast, stomach) Pulmonary hypertension (>60mmHg) Rhythm disturbances (AF, LBBB etc) 3/17 pts 3/17 pts 6/17 pts 5/17 pts 2/17 pts 10/17 pts 5/17 pts 3/17 pts 4/17 pts 6/17 pts Attikon University Hospital - Department of Cardiothoracic Surgery
9 69 yo female severe AVS 4 hospitalizations (syncope, CHF, AF) Stage 3 CKD (GFR 37ml/min) COPD Echo: Vmax 4,8 m/s, MG 50 mmhg) Logistic EuroSCORE: 21,73% EuroSCORE ΙΙ: 13,62% Coro: LM + 3 VD Heart Team Case 1 Attikon University Hospital - Department of Cardiac Surgery
10 Case 1 CABG X 3 + RDAVR (Edwards Intuity No 23) Implantation time: 9 min ICU: 18 hours Discharged 8 th pod 18 months f-up: SR, EF 60%, mean gradient 6 mmhg, no paravalvular leak Attikon University Hospital - Department of Cardiac Surgery
11 Case 2 RDAVR (Edwards Intuity No 21) + TV repair (cleft closure + ring No 30) Implantation time: 10 min 14 months f-up: AF, EF 60%, mean gradient 5 mmhg, no paravalvular leak Attikon University Hospital - Department of Cardiac Surgery
12 Results Concomitant procedures (11/17 pts): CABG (X 1-3): 7 patients Tricuspid valve repair + annuloplasty: 1 case Aortic root endarterectomy: 2 cases Subvalvular ring excision: 1 case Minimally invasive RDAVR (mini-sternotomy): 3 pts Attikon University Hospital - Department of Cardiac Surgery
13 Results Peak gradient (post-op): 14.9±4.2 mmhg Mean gradient (post-op): 6.8±2.5 mmhg Paravalvular leaks: 0 ICU stay: 1,76 days (< 24h for 14/17 pts) Mean hospitalization: 10 days Attikon University Hospital - Department of Cardiac Surgery
14 Results morbidity & mortality Mortality: 0 (up to 18 months of f-up) Perioperative complications: Temporary AKI (3 pts 1 prisma) Pharyngeal injury (TOE) Bleeding (1 pt) Permanent pacemaker: 1/17 case (5.18%) 10 days after discharge Attikon University Hospital - Department of Cardiac Surgery
15 Rapid deployment AVR Attikon University Hospital - Department of Cardiac Surgery
16 CADENCE-MIS trial nn Thorac Surg 2015;99:17 25 Attikon University Hospital - Department of Cardiac Surgery
17 TAVI (Partner 1) Moderate or severe aortic regurgitation TAVI Surgical AVR (Partner 2) (Partner 1) 14% 3,7% 1% 0,9% RD AVR (Intuity) Triton Trial Attikon University Hospital - Department of Cardiac Surgery
18 Cost of the devices in Greece (ΕΠΥ) Bioprosthetic valves (S-AVR) Rapid deployment or Trans-catheter valves (TAVI) X 0,5 sutureless valves (RD-AVR) X 3, Euro 6600 Euro Euro Attikon University Hospital - Department of Cardiac Surgery
19 Conclusions Rapid deployment AVR is new method of surgical treatment of severe AVS This new generation of hybrid valves has the advantages of: Faster implantation Excellent hemodynamics Easier minimally invasive techniques Application of this method in high surgical risk patients seams: Effective Safe Cost effective? Attikon University Hospital - Department of Cardiac Surgery
20 Thank you!! Attikon University Hospital - Department of Cardiac Surgery
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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,
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
VALVULOPATIE: NUOVE SOLUZIONI.
VALVULOPATIE: NUOVE SOLUZIONI www.fisiokinesiterapia.biz Nkomo, Lancet 2006 ELDERLY POPULATION PROJECTION IN USA 65-84 Years Old 85 and Older 77,2 Millions of people 34,8 4,3 30,5 53,8 6,8 47 14,3 62,9
Alec Vahanian,FESC, FRCP (Edin.) Bichat Hospital University Paris VII, Paris, France
Future Percutaneous Therapies for Mitral Valve Disease (Mitraclip,percutaneous annuloplasty and transcatheter valve implantation) Will they reach the TAVI s success? Alec Vahanian,FESC, FRCP (Edin.) Bichat
CoreValve in a Degenerative Surgical Valve
CoreValve in a Degenerative Surgical Valve Ran Kornowski, MD, FESC, FACC Chairman Department of Cardiology Rabin Medical Center, Petach Tikva, Israel Disclosure Statement of Financial Interest I, Ran Kornowski,
22/06/2017. Oxford City. Transcatheter aortic valve replacement 2017 guidelines. 1. First time I have heard about it. 2.
Oxford City Transcatheter aortic valve replacement 2017 guidelines Monday 19 th June Jim Newton Oxford Oxford University Hospitals NHS FT How familiar are you with TAVR? 1. First time I have heard about
Transcatheter Echo Guided Mitral Valve Repair with NeoChord Implantation: Results from NeoChord Independent International Registry
Transcatheter Echo Guided Mitral Valve Repair with NeoChord Implantation: Results from NeoChord Independent International Registry A. Colli, E. Bizzotto, E. Manzan, L. Besola, F. Zucchetta, D.Pittarello,
Sotirios N. Prapas, M.D., Ph.D, F.E.C.T.S.
CORONARY ARTERY REVASCULARIZATION WITH MILD AORTIC STENOSIS: STRATEGIES OF TREATMENT 9 th ANNUAL MEETING OF THE EAB SOCIETY, Pravets, Bulgaria, 2012 Sotirios N. Prapas, M.D., Ph.D, F.E.C.T.S. Director
Welcome 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
8. Nov, 2018 Athens Clossroad 2018, Athens GREEK
8. Nov, 2018 Athens Clossroad 2018, Athens GREEK Stent Less Bio prosthesis Aortic Valve replacement with Minimally Invasive Approach ~ Indication for the 1 st Surgical Aortic Valve Treatment Considering
Bernard De Bruyne, MD, PhD Cardiovascular Center Aalst OLV-Clinic Aalst, Belgium
Medium Term Survival and Functional Status in Patients with Severe Aortic Stenosis Treated by Transcatheter Aortic Valvular Implantation in the PARTNER EU Trial Bernard De Bruyne, MD, PhD Cardiovascular
Masterclass III Advances in cardiac intervention. Percutaneous valvular intervention a novel approach
Masterclass III Advances in cardiac intervention Percutaneous valvular intervention a novel approach Professor Roger Boyle CBE National Director for Heart Disease and Stroke London Medical therapy Medical
TAVI, TMVI, TEVAR, EVAR: The end of standard Cardiovascular Surgery? Perspectives of a Cardiac Surgeon
TAVI, TMVI, TEVAR, EVAR: The end of standard Cardiovascular Surgery? Perspectives of a Cardiac Surgeon Daniel Fink MD Dept. of Cardiothoracic Surgery Shaare Zedek Medical Center Jerusalem, Israel Disclosures
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,
Minimally invasive aortic valve replacement in high risk patient groups
Review Article Minimally invasive aortic valve replacement in high risk patient groups Daniel Fudulu, Harriet Lewis, Umberto Benedetto, Massimo Caputo, Gianni Angelini, Hunaid A. Vohra Department of Cardiac
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
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
Aortic 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