tavi
DESCRIPTION
TRANSCRIPT
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TAVI procedures with combined Sapien and CoreValve prosthesis:
early experience in a single Center
Gian Luca Martinelli MDCV Surgery Dept.
S Anna Hospital – Catanzaro - Italy
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Yes
Femoral Access
Evaluation Y/N
Femoral Access
Evaluation Y/N
Yes No No
Not in Study
Transfemoral VS
1:1 Randomization
1:1 Randomization
1:1 Randomization
Transfemoral
Medical Management ControlVS
Cohort B
Yes
No
AVR Control
Trans apical
AVR Control
OPERABLEASSESMENT
VS
Cohort A ~650 pts ~350 pts
Yes
Femoral Access
Evaluation Y/N
Femoral Access
Evaluation Y/N
Yes No No
Not in Study
Transfemoral VS
1:1 Randomization
1:1 Randomization
1:1 Randomization
Transfemoral
Medical Management ControlVS
Cohort B
Yes
No
AVR Control
Trans apical
AVR Control
OPERABLEASSESMENT
VS
Cohort A ~650 pts ~350 pts
• Fully enrolled. • 1st results by Q4-2010
PARTNER IDEThe world’s first and only prospective, multicenter, randomized clinical trial to
compare transcatheter heart valve replacement to conventional AVR and medicalmanagement.
Primary endpoint: one year survival plus extensive 5-year follow-up
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Indications to TAVI procedure at S.Anna Hospital
Symptomatic Severe Aortic Stenosis
• Operative High Risk scores ( logES > 20%)
• Controindications to open surgery
• More recently, age over 80.
129129 patients were submitted to TAVIprocedure between 2010/2011
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Patients CharacteristicsVariable TAVI ( N= 129)
Age, y 80,4 ± 5.5
Female gender, n(%) 76( 58.4%)
NYHA class 3.2 ± 0.5
IMA n(%) 58(45%)
Neurological dysfuction or stroke n(%) 36(28%)
Chronic Kidney failure n(%) 29(23%)
COPD n(%) 60(47%)
Liver cirrosis 10(8%)
Previous open heart surgery n(%) 9 (6.9)
Previous PCI n(%) 13 (10.7)
Previous PMK implantation n(%) 14(11%)
Atrial Fibrillation, n(%) 5(4%)
Logistic Euroscore, % 22.3 ± 11
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VASCULAR ACCESSSapien100 and CoreValve 29
75% of cases in general anesthesia
Transfemoral 98
Transaortic 3
Transapical 28
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Early results
• Global In-hospital Mortality : 13/129 (10.1%)
• 5 related to the procedure (aortic dissection, anulus rupture, occlusion of right coronary, 2 embolizations)
• 2 Low Cardiac output
• 2 ARDS
• 2 MOF
• 1 ICH
• 1 GI bleeding
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Early results according to vascular access
• In-hospital Mortality (TF approach): 5/98 (5.1%)• mean LogES: 20.4. ± 12.8%
• mean LogES ( death group) 35.3 ± 28.3%
• In-hospital Mortality (TA approach): 7/28 (25%)• mean LogES: 26.1 ± 14.4%
• mean LogES ( death group) 38.7 ± 18.5%
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Perioperative Complications
• 5 cases of conversion to AVR ( only 1 death): • 1 Embolization into the Aorta
• 2 Embolization into the Ventricular Cavity
• 1 Residual Severe AR
• 1 Rupture on Non Coronary Sinus
• IMA 2 pts (1.5%)
• Stroke: 2 pts (1.5%)
• Major Vascular complication: 6 pts (4.6%)
• Minor Vascular complications: 6 pts (4.6%)
• Acute Renal Failure (VARC) 9 pts (6.9%)
• PMK implantation 8 pts ( 6.2%)
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SURVIVAL (Kaplan-Meyer Method)Follow-up: 9.9 ± 7 mth
Late Death: 9 pts1 Cardiac related8 Non Cardiac related
2 late reoperations:1 endocarditisSevere AR in valve in valve with bioprosthetic failure
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9.5 + 3.1
EF>50
30>EF>50
EF<30
EF>50
30>EF>50
EF<30
EF>50
30>EF>50
EF<30
At Fup, only 1 pt has more than AR > 2
p<0.01
p=0.2p<0.01
p=0.3
p<0.01p=0.2
p<0.01
p=0.1
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Goal of the procedure
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Reduction of AR after 30 min
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Valve in Valve
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Treatment of AR>2+ after procedure
• Valve in valve
• BAV
• Repositioning of prosthesis
• AVR
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Prosthesis Embolization
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Embolia in ventricolo (spina)
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Prosthesis Embolization
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Prosthesis Embolization
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Coronary occlusion
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Coronary occlusion
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Successful THV PROGRAM
Patient-Focused Multidisciplinary Heart ValveTeam Approach
RadiologistRadiologist
EchocardiographistEchocardiographist
CardiologistCardiologistCardiac SurgeonCardiac Surgeon
AnesthesiologistAnesthesiologist
Excellent Visualization
Patient Selection
Patient Management
Procedure Planning
Hybrid Suite
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TAVI is an approachto the patient….
not just a procedure
Conclusion
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THANK YOU
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Late Endocarditis
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Treatment of bioproshesis degeneration: the role of TAVI
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Role of TAVI in isolated AR
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Eco pre e post impianto di Attanasio su centricity redux di TD
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Multidisciplinary Imaging Approach
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Between Dec 2010 and Jan 2012
325 patients were treated for isolated AS.
129129 patients were submitted to TAVIprocedure
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Sapient XT(77.5%)
CoreValve(22.5%)
TF
TA
TAo
TF
TAo
75% in general anesthesia
Operative Data70
28
2
28
1