Tavi

1,577 views

Published on

Published in: Health & Medicine
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,577
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
59
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Tavi

  1. 1. TAVI procedures with combined Sapien and CoreValve prosthesis:early experience in a single Center Gian Luca Martinelli MD CV Surgery Dept. S Anna Hospital – Catanzaro - Italy
  2. 2. PARTNER IDE The world’s first and only prospective, multicenter, randomized clinical trial to compare transcatheter heart valve replacement to conventional AVR and medical management. OPERABLE Yes ASSESMENT No Cohort A ~650 pts Cohort B ~350 pts Femoral Femoral Access Access Yes Evaluation No Yes Evaluation No Y/N Y/N Not in Study 1:1 1:1 1:1 Randomization Randomization Randomization Trans AVR Trans AVR Trans Medical Management VS VS VS femoral Control apical Control femoral ControlPrimary endpoint: one year survival plus extensive 5-year follow-up • Fully enrolled. • 1st results by Q4-2010
  3. 3. 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. 129 patients were submitted to TAVI procedure between 2010/2011
  4. 4. Patients CharacteristicsVariable TAVI ( N= 129)Age, y 80,4 ± 5.5Female gender, n(%) 76( 58.4%)NYHA class 3.2 ± 0.5IMA 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
  5. 5. VASCULAR ACCESS Sapien100 and CoreValve 29 75% of cases in general anesthesiaTransaortic 3 Transapical 28 Transfemoral 98
  6. 6. 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
  7. 7. 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%
  8. 8. 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%)
  9. 9. SURVIVAL (Kaplan-Meyer Method) Follow-up: 9.9 ± 7 mthLate Death: 9 pts1 Cardiac related8 Non Cardiac related2 late reoperations:1 endocarditisSevere AR in valve invalve with bioprostheticfailure
  10. 10. p<0.01 p<0.01 p=0.2 p=0.3 9.5 + 3.1 p<0.01 p=0.1EF>50 EF>50 EF>50 p<0.01 p=0.230>EF>50 30>EF>50 30>EF>50EF<30 EF<30 EF<30 At Fup, only 1 pt has more than AR > 2
  11. 11. Goal of the procedure
  12. 12. Reduction of AR after 30 min
  13. 13. Valve in Valve
  14. 14. Treatment of AR>2+ after procedure • Valve in valve • BAV • Repositioning of prosthesis • AVR
  15. 15. Prosthesis Embolization
  16. 16. Embolia in ventricolo (spina)
  17. 17. Prosthesis Embolization
  18. 18. Prosthesis Embolization
  19. 19. Coronary occlusion
  20. 20. Coronary occlusion
  21. 21. Patient-Focused Multidisciplinary Heart Valve Team Approach Radiologist Patient SelectionAnesthesiologist Echocardiographist Successful Patient THV Excellent Management Visualization PROGRAM Procedure Planning Cardiac Surgeon Cardiologist Hybrid Suite
  22. 22. ConclusionTAVI is an approach to the patient….not just a procedure
  23. 23. THANK YOU
  24. 24. Late Endocarditis
  25. 25. Treatment of bioproshesisdegeneration: the role of TAVI
  26. 26. Role of TAVI in isolated AR
  27. 27. Eco pre e post impianto di Attanasio su centricity redux di TD
  28. 28. Multidisciplinary Imaging Approach
  29. 29. Between Dec 2010 and Jan 2012325 patients were treated for isolated AS. 129 patients were submitted to TAVI procedure
  30. 30. Operative Data TF 70Sapient XT TA 28 (77.5%) 2 TAoCoreValve TF 28 (22.5%) TAo 1 75% in general anesthesia

×