Transapical Aortic Valve Implantation
SHA, GHA , Riyadh, Feb 2013
SHA, GHA , Riyadh, Feb 2013
SHA, GHA , Riyadh, Feb 2013
SHA, GHA , Riyadh, Feb 2013
Fundamentals for TAVI Program
(4 T) Theory (Rationale) Team work Training Technology &Equipments SHA, GHA , Riyadh, Feb 2013
Joint Task Force Positioning Paper: ”‟Transcatheter valve implantations for patients with Aortic Stenosis
Technique is feasible and provides hemodynamic ″ ″ and clinical improvements for up to 2 years This technique should be restricted to high-risk″ ″ patients or those with contraindications for surgery SHA, GHA , Riyadh, Feb 2013
Team
Work
Training
SHA, GHA , Riyadh, Feb 2013
Technology & Equipment
INDICATIONS
Patient Selection The following are the four steps of patient
selection:
confirmation the severity of AS; evaluation of symptoms; analysis of the Risk of surgery / Evaluation of
life expectancy and quality of life; assessment of the feasibility and exclusion of contraindications for TAVI.
SHA, GHA , Riyadh, Feb 2013
:Transapical Indication Diffuse Peripheral Vessels Small vessel Diameter (less than 6 mm) For Novaflex system
Porcelain Aorta Extensive tortuosity of vessels Unable to cross native valve & Failure of BAV TF procedural complications
SHA, GHA , Riyadh, Feb 2013
!!Not Only Euro & STS score
SHA, GHA , Riyadh, Feb 2013
( TAVI ) :The Saudi experience
.Immediate and 18 Months Follow-Up
Prince Sultan Cardiac Center & King Faisal Specialist Hospital and Research Center, Riyadh , Saudi Arabia
TAVI The Saudi Experience April 2009 – October 2010 (Total of 42 patients)
27 TA Ed Sabien
15 TF Ed Sabien
SHA, GHA , Riyadh, Feb 2013
OBJECTIVES: To evaluate the immediate and intermediate results of Edward’s Sapien Transfemoral (TF) and Transapical (TA) TAVI done in Saudi Arabia with 18 months F/U.
SHA, GHA , Riyadh, Feb 2013
TAVI Patient’s Data Edwards Sapien Valve (N=42) Demographic Data Demographic Data
Min/Max
Average
Euroscore
49/ 10
38+ 13
Age (yrs)
105/ 55
+ 880.9
F/M) Gender )
42 / 18
EF
65 / 25
PAP (s)
80/ 25
42.9%
SHA, GHA , Riyadh, Feb 2013
%47.9+7
49.6+10 mmHg
TAVI Patient’s Data Edwards Sapien Valve (N=42) Demographic Data COPD
15/42
35.7%
Renal Impairment ((Cr>200 CVA
18/42
42.9%
8/42
19%
PVD
25/42
59.5%
Porcelain Aorta
7/42
16.7%
CAD or previous PCI
57.1%
Pre-TAVI PCI
24/42 9/42
Previous CABG
11/42
% 26.2
SHA, GHA , Riyadh, Feb 2013
21.4%
(Technique) Transapical to Transfemoral Ratio (n=42)
SHA, GHA , Riyadh, Feb 2013
Edwards Sapien Valve Size 23 mm Vs Size 26 mm (42=(n
SHA, GHA , Riyadh, Feb 2013
TAVI Patient’s Data Edwards Sapien Valve (N=42)
Postoperative Outcome Demographic Data
Min/Max
Mean
Hospital Stay (days)
30<-- 2
8.5+4 days (Median 7 days(
Over all Mortality (1 month)
42/ 5
11.9%
18 month Survival
37/42
88.1%
88.1%
month survival 18
SHA, GHA , Riyadh, Feb 2013
TAVI 6m, 12m, 18m Survival ( (n=42
SHA, GHA , Riyadh, Feb 2013
Post TAVI Paravalvular Leak ((n=42
SHA, GHA , Riyadh, Feb 2013
TAVI Patient’s Data Edwards Sapien Valve
(N=42)
Postoperative Data DATA Postoperative Peak AV Gradient Postoperative EF Postoperative PAP
MIN/MAX
Mean
P value
33 - 8
10.8+4 mmHg 52.2+4%
p<0.0001
37.8+ 6 mmHg
P<0.033
65% – 25 80 – 25 mm Hg
SHA, GHA , Riyadh, Feb 2013
P<0.012
TAVI Patientâ&#x20AC;&#x2122;s Data Edwards Sapien Valve
(N=42)
Postoperative Complications Cardiac Tamponade
2/42
% 4.8
Apical Tear
1/42
2.4 %
Coronary artery occlusion/Embolisation
1/42
2.4 %
Postoperative Bleeding (Reopening)
3/42
% 7.1
SHA, GHA , Riyadh, Feb 2013
TAVI Patientâ&#x20AC;&#x2122;s Data Edwards Sapien Valve (N=42) Postoperative Complications
Postop PPM
1/42
% 2.4
Postop CVA
1 / 42
2.4%
Postop Dialysis
5/42
11.9 %
Vascular Complications Re-intubation
2/42
% 4.8
3/42
7.1%
Wound Infection
2/42
% 4.8
SHA, GHA , Riyadh, Feb 2013
[Eur J Cardiothorac Surg. 2012 Aug 11. [Epub ahead of print
Transapical aortic valve replacement in extreme-risk patients: .outcome, risk factors and mid-term results
.Ferrari E, Namasivayam J, Marcucci C, Gronchi F, Berdajs D, Niclauss L, von Segesser LK
( extreme-risk' patients underwent transapical TAVR (TA-TAVR '40 (. EuroSCORE above 35%) , Variables were analysed as risk factors for hospital and mid-term mortality .and a 2-year follow-up (FU) was obtained Mean FU time was 24 months: actuarial survival estimates for all-cause mortality at 6 months, 1 year, 18 months and 2 years were 68, 57, 54 and .54%, respectively
:CONCLUSIONS TA-TAVR in extreme-risk patients carries a moderate risk of hospital mortality. Severe comorbidities and presence of residual paravalvular leakages affect the mid-term survival, whereas surviving patients have an acceptable quality of life .without rehospitalizations for cardiac decompensation SHA, GHA , Riyadh, Feb 2013
CLINICAL RESEARCH
European Heart Journal (2010) 31, 1398–1403 doi:10.1093/eurheartj/ehq060
Valvular heart disease
Transapical aortic valve implantation in 100 consecutive patients: comparison to propensitymatched conventional aortic valve replacement Thomas W alther 1,* , Gerhard Schuler 2, Michael A. Borger 1, Jo¨rg Kempfert 1, Jo¨ rg Seeburger 1, Yvonne Ru¨ckert 1, Jo¨rg Ender 3, Axel Linke 2, Markus Scholz 4, Volkmar Falk 1, and Friedrich W . Mohr 1 1
Department of Cardiac Surgery, Heartcenter, University Leipzig, Herzzentrum, Klinik fu¨r Herzchirurgie, Stru¨mpellstrasse 39, Leipzig 04289, Germany; 2 Department of Cardiology, 3
4
Epidemiology, Leipzig, Germany Received 14 July 2009; revised 15 December 2009; accepted 19 January 2010; online publish-ahead-of-print 16 March 2010
A im s To evaluate the outcome of transapical aortic valve implantation (TA-AVI) in comparison to conventional surgery. ..................................................................................................................................................................................... Met hods One hundred consecutive high-risk patients with symptomatic aortic valve stenosis received TA-AVI using the and r esult s Edwards SAPIEN TM pericardial xenograft between February 2006 and January 2008. Patient age was 82.7+ 5 years, 77 were females, logistic EuroSCORE predicted risk of mortality was 29.4+ 13% and Society Thoracic Surgeons score risk for mortality was 15.2+ 8.3%. Propensity score analysis was used to identify a control group of patients that underwent conventional aortic valve replacement (C-AVR). Transapical aortic valve implantation was performed successfully in 97 patients, whereas three patients required early conversion. There were no new onset neurological events in the TA-AVI group and early extubation was performed in 82 patients. Echocardiography revealed good valve function with low transvalvular gradients in all patients. Thirty-day survival was 90+ 3 vs. 85+ 4% for TA-AVI vs. C-AVR, and 1-year survival was 73+ 4 vs. 69+ 5%(P¼ 0.55). ..................................................................................................................................................................................... Conclusion Transapical aortic valve implantation is a safe, minimally invasive, and off-pump technique to treat high-risk patients with aortic stenosis. Results of the initial 100 patients are good and compare favourably to conventional surgery.
----------------------------------------------------------------------------------------------------------------------------------------------------------Keywords
Aortic valve † Aortic stenosis † Transcatheter † Transapical aortic valve implantation † Aortic valve replacement
: CONCLUSION TA-AVI is a feasible technique for high risk AS
WHENEVER THE VASCULAR ACCESS IS DIFFICULT, with high success rate and acceptable complications.
Long term results and Survival benefits still to
be determined.
SHA, GHA , Riyadh, Feb 2013