Tình hình thay van động mạch chủ qua đường ống thông ở hoa kỳ current status of TAVR in the US

Eng, MD FSCAI FACC Assistant Professor of Medicine Division of Cardiology University of Texas Health Sciences Center San Antonio, Texas... Disclosures • Speakers Bureau for Edwards Li

TAVR Update 2014

Marvin H Eng, MD FSCAI FACC

Assistant Professor of Medicine

Division of Cardiology

University of Texas Health Sciences Center San Antonio, Texas

Disclosures

• Speakers Bureau for Edwards Lifesciences

• Consultant for NAVIGATE CSI

Goals of Percutaneous Valve Therapy

Edwards Balloon-Expandable Valves

Edwards Balloon-Expandable Valves

Access- XT

Sheath ID Sheath OD Sheath OD

Expanded

Minimum Vessel Diameter

23 mm 16Fr 6.7 mm 8.9 mm 6.0 mm

26 mm 18 Fr 7.2 mm 8.9 mm 6.5 mm

29 mm 20 Fr 8.0 mm 9.9 mm 7.0 mm

PARTNER I-A

Leon MB ACC 2013

Edwards Sapien PARTNER IB 5 Year data

PARTNER I-B

Kapadia S TCT 2014

Overall N= 150

Self-Expanding

Medtronic CoreValve Series

Engager TA 23/26 mm

Sheath Size (ID) 18Fr 14Fr 29Fr

Access TF, SC, TAo TF, SC, TAo TA, TAo

Medtronic CoreValve vs SAVR Increased Surgical Risk

Adams DH et al NEJM 2014;370:

1790-1798

CoreValve- Extreme Risk Registry Paravalvular Leak

Popma, JJ et al JACC 2014; 63:1972-81

CHOICE

Aortic insufficiency

Abdel-Wahab M et al TCT 2014 Washington D.C

Self-Expanding Valves

Direct Flow

Schoafer J et al JACC 2014;63: 763-8

Bijuklic C et al Eurointervention 2013;8:Q75-8

• 23, 25, 27, 29 mm valves

– 19-28 mm annuli

– 18Fr

– Conformable polyester cuff

– Rings pressurized with saline and contrast

– Infuse polymer to solidify rings

Direct Flow

Inner Curve Technique

DeMarco F et al Eurointervention 2014;10 :400-402

P-value

Death 1.9% (2) 1.3%(1) 0.768

Stroke 1.9% (2) 4% (3) 0.651 Major Vascular

MI 1.9% 1.9% Major Vascular

Complication

5.8% 6.8% Major Bleeding 3.9% 3.9%

Manoharan G et al TCT 2014 Washington D.C

“Mechanical Expanding” Valve

Lotus Valve

“Mechanical” Deployment

Merideth, I et al EuroIntervention 2014;9: 1264-1270

Lotus Valve in High Risk Pts

REPRISE II- 1 Year (n=120)

Merideth, I et al TCT 2014 Washington D.C

Event Discharge 7d 30 Days 1 Year

CV Death 3.3% (4/120) 4.2% (5/119) 6.7% (8/119) Disabling stroke 1.7% (2/120) 1.7% (2/119) 3.4% (4/119) Non-disabling

stroke

4.2% (5/120) 4.2% (5/119) 5.9% (7/119) Total stroke 5.9% (7/120) 31.9% 5.9% (7/119) 9.3% (11/119)

Other Valves

Accurate, Jena, Innovare, Syntheon

Stroke Prevention

Embolic Protection

• CLEAN-TAVI (Claret Device)

– Randomized 100 patients 1:1

• SENTINEL (Claret device)

– Randomizing 360 TAVI patients

– MRI study 4-7 days post-procedure

• PROTAVI-C

– Embrella device

– At least as many lesions with Device

• Keystone TRIGUARD

– Protects entire arch

Samim M et al EuroPCR 2014 Kodali S et al TCT 2013

Iterative Advances

TAVI

• TAVI in Intermediate Risk

– OBSERVANT- Registry Data

– PARTNER IIA-Randomized Data

– S3 Prospective Data

• Patient Selection

– Cohort C

• New THV’s

• Valve Sizing and Selection

– CT, 3D-TEE, Calcium Distribution

• Prevention of In-Hospital Complications

cảm ơn bạn!

CoreValve

Extreme-Risk Prospective Registry

Yakubov SJ et al TCT 2014 Washington D.C

TAVI- MCV

Aortic Regurgitation (n=43)

Roy, R et al JACC 2013;61:1577-84