TAVI between dreams and reality
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1. Transcatheter aortic valve implantation (TAVI) was first performed in humans in 2002 in France using a bovine pericardium valve. 2. There are several vascular access approaches for TAVI, including transfemoral, transapical, transaortic, and subclavian approaches. 3. A 2013 feasibility study of a new device for TAVI in patients with aortic insufficiency reported successful deployment in all four patients with no deaths at 30 days and improved aortic insufficiency in all patients.
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Trans aortic tavi
The document describes a case where a 81 year old woman with severe aortic stenosis and comorbidities underwent a transaortic aortic valve implantation (TA-AVI) through an upper ministernotomy approach. Key steps included making a 5cm J-shaped incision, inserting an 8Fr sheath through the aorta, crossing the native valve with a wire, inserting a delivery system, performing balloon aortic valvuloplasty, and releasing the new valve. The procedure was successful with normal valve function and recovery. The upper ministernotomy provides an alternative access for patients not suitable for transfemoral approaches and avoids arch crossing.
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This document provides an overview of trans-catheter aortic valve implantation (TAVI). It discusses the indications for TAVI including symptomatic severe aortic stenosis in high-risk surgical patients. The pre-procedural workup involves imaging to assess anatomy and risk. The procedure involves accessing the femoral or other arteries and deploying a balloon-expandable or self-expanding bioprosthetic valve. Complications include conduction abnormalities, paravalvular regurgitation, and hypotension. Two clinical cases are presented of high-risk patients undergoing TAVI.
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Tavi is the evidence catching up with reality
1. Two large European registries showed TAVI to have high technical success rates of 98-99% and 30-day mortality of 12% for inoperable patients, demonstrating its safety and efficacy in real-world settings.
2. The PARTNER Trial Cohort B was the first randomized controlled trial of TAVI versus standard therapy and showed TAVI to be superior to standard therapy in reducing 1-year mortality for inoperable patients.
3. The PARTNER Trial Cohort A randomized high surgical risk patients to TAVI or SAVR and found non-inferiority of TAVI to SAVR with lower rates of bleeding, atrial fibrillation, and shorter hospital stays for TAVI
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This document discusses transcatheter aortic valve implantation (TAVI) and the risk of cerebral embolization during the procedure. TAVI is a minimally invasive procedure used to treat aortic stenosis that is growing rapidly worldwide. However, TAVI is associated with a risk of stroke between 2-4% within 30 days after the procedure due to cerebral embolization of debris. The document proposes developing a solution to reduce the risk of cerebral embolization and associated strokes during TAVI by at least 50%. It outlines criteria for an effective solution, competitive advantages over existing devices, hurdles to overcome, as well as the large market potential given the growth of TAVI procedures globally.
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Trans aortic tavi
The document describes a case where a 81 year old woman with severe aortic stenosis and comorbidities underwent a transaortic aortic valve implantation (TA-AVI) through an upper ministernotomy approach. Key steps included making a 5cm J-shaped incision, inserting an 8Fr sheath through the aorta, crossing the native valve with a wire, inserting a delivery system, performing balloon aortic valvuloplasty, and releasing the new valve. The procedure was successful with normal valve function and recovery. The upper ministernotomy provides an alternative access for patients not suitable for transfemoral approaches and avoids arch crossing.
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1. Two large European registries showed TAVI to have high technical success rates of 98-99% and 30-day mortality of 12% for inoperable patients, demonstrating its safety and efficacy in real-world settings.
2. The PARTNER Trial Cohort B was the first randomized controlled trial of TAVI versus standard therapy and showed TAVI to be superior to standard therapy in reducing 1-year mortality for inoperable patients.
3. The PARTNER Trial Cohort A randomized high surgical risk patients to TAVI or SAVR and found non-inferiority of TAVI to SAVR with lower rates of bleeding, atrial fibrillation, and shorter hospital stays for TAVI
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Evaluation of patients considered for TAVI
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This document discusses transcatheter aortic valve implantation (TAVI) and the risk of cerebral embolization during the procedure. TAVI is a minimally invasive procedure used to treat aortic stenosis that is growing rapidly worldwide. However, TAVI is associated with a risk of stroke between 2-4% within 30 days after the procedure due to cerebral embolization of debris. The document proposes developing a solution to reduce the risk of cerebral embolization and associated strokes during TAVI by at least 50%. It outlines criteria for an effective solution, competitive advantages over existing devices, hurdles to overcome, as well as the large market potential given the growth of TAVI procedures globally.
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Echocardiography plays an important role in the care of patients undergoing transcatheter aortic valve implantation (TAVI). Pre-procedurally, echocardiography is used to confirm the severity of aortic stenosis, assess the aortic annulus size, exclude contraindications like left ventricular thrombus, and help determine the optimal access route. During TAVI, echocardiography guides valve selection and positioning, identifies complications, and can help address issues like paravalvular regurgitation. Post-procedure, echocardiography is crucial for long-term monitoring of valve function and the detection of any late complications.
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Transcatheter aortic valve implantation (TAVI) has been developed as an alternative to surgical aortic valve replacement for high-risk patients. TAVI involves threading a collapsible valve through blood vessels and implanting it to replace the diseased valve. Over 30,000 high-risk patients with severe aortic stenosis have undergone TAVI, based on evidence from studies showing it is safer than surgery for this group. TAVI indications may expand as longer-term data on outcomes becomes available and the procedure requires a multidisciplinary team approach and dedicated training.
PERCUTANEOUS TREATMENT STRATEGIES OF VALVULAR HEART DISEASE
This document discusses various percutaneous treatment strategies for valvular heart disease, focusing on mitral valve repair techniques. It provides an overview of early balloon valvuloplasty procedures and more recent advances like the MitraClip device for mitral regurgitation repair. The document reviews clinical trials that demonstrated the safety and efficacy of the MitraClip, as well as its current FDA approval status. It also discusses alternative percutaneous mitral repair approaches like indirect annuloplasty via the coronary sinus.
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1. Endovascular techniques are increasingly being used to treat aortic pathologies like aneurysms and dissections as they can reduce mortality and morbidity compared to open surgery.
2. However, many challenging cases involve the ascending aorta and aortic arch, which are still difficult to treat using endovascular methods alone due to anatomical constraints.
3. Hybrid procedures combining endovascular and open surgical techniques show promise for expanding the applications of endovascular therapy in complex cases, with extra-anatomic bypass grafts and branches helping to create adequate landing zones for endografts.
T evar
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This document describes the step-by-step procedure for transseptal valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) using an Edwards SAPIEN 3 valve. Key steps include patient selection and imaging to assess risk of left ventricular outflow tract obstruction, transseptal puncture to access the left atrium, valve deployment under rapid pacing, and closure of the septal defect if needed. ViV-TMVR provides an alternative to repeat surgery for high-risk patients with a failing bioprosthetic mitral valve. The major risk is left ventricular outflow tract obstruction, which techniques like alcohol septal ablation aim to prevent.
TAVI. What’s next? by Dr Susanna Price
The prevalence of degenerative valvular disease is increasing in the context of an increasingly ageing population, and despite advances in medical and surgical interventions, is associated with a significantly worse outcome when compared with the general population. Data from the EuroHeart Survey (2003) suggests the commonest relates to native valve disease (predominantly aortic stenosis) however, more than one quarter of patients with valve disease have undergone a previous intervention. According to current guidelines, in general treatment for severe, symptomatic aortic stenosis is surgical aortic valve replacement, which is associated with excellent outcomes, however, despite this around 30% of such patients do not undergo surgical intervention.
The last decade has seen a significant change in the potential therapeutic options for patients with aortic valve disease due to the development of transcatheter techniques for valve implantation. Patented in 1991, the first successful human implant of a transcatheter aortic valve was undertaken in 2002, with currently >500,000 implantations having been undertaken in >70 countries worldwide. The evidence supporting transcatheter aortic valve implantation (TAVI) otherwise known as transcatheter aortic valve replacement (TAVR) came originally from the key PARTNER studies, where patients judged to have inoperable aortic stenosis who underwent TAVI having improved survival and a reduction in hospital admission at 1 year. Following the early safety and efficacy studies, and following increasing recommendations for TAVI as an option for patients at high risk in international guidelines, the use of transcatheter techniques is extending to those of lower risk.
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Hybrid repair of Thoracoabdominal Aneurysm
1. Classifications and treatment options for thoracoabdominal aortic aneurysms (TAAAs) are discussed, including open repair, endovascular repair (TEVAR), and hybrid procedures combining open and endovascular techniques.
2. Complications of open TAAA repair can include ischemia-induced injury to organs and spinal cord paralysis, while endovascular options may reduce blood loss, stress response, and recovery time.
3. Hybrid procedures involving surgical debranching of visceral arteries combined with TEVAR can benefit high-risk patients and provide alternatives to open repair, with lower reported complications and mortality compared to open surgery.
Endovascular Aortic Aneurysm Repair
The document discusses endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. It presents a case of a 62-year-old male undergoing EVAR for a 5.5cm AAA. EVAR involves deploying a graft via catheter to exclude the aneurysm from blood flow. Complications can include endoleaks, where blood leaks outside the graft but within the aneurysm sac. The main types of endoleaks are type I (inadequate seal at graft ends), type II (collaterals inside the sac), and type III (graft component disruption). EVAR has advantages over open repair like less invasiveness but risks like increased reintervention rates.
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2. The MitraClip procedure involves inserting a clip via the femoral vein to grasp and repair the mitral valve leaflets in a technique similar to the surgical Alfieri repair.
3. The key steps involve transseptal puncture, advancing the clip delivery system into the left atrium, positioning the clip below the mitral valve, grasping the leaflets with the clip, and releasing the clip to create a double orifice mitral valve.
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This document reviews endovascular repair (TEVAR) for ruptured thoracic aortic aneurysms. It provides data on the incidence, mortality rates, and management of ruptured thoracic aneurysms. Open surgical intervention has mortality rates of 18-27% while TEVAR has shown lower 30-day mortality rates of 11-17% in single-institution studies. However, TEVAR is associated with higher mortality risks in older patients (>75 years old) and those with hemodynamic instability. The document recommends TEVAR as a less invasive alternative to open surgery for ruptured thoracic aneurysms, particularly when performed at experienced centers.
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Peter Hansen is a Cardiologist with a particular interest in Transcatheter Aortic Valve Implantation. This talk is all about TAVI's and imaging used to assess them. You may be seeing a lot more TAVI's so this superb insight from an expert is invaluable.
Role of echo in tavi
Echocardiography plays an important role in the care of patients undergoing transcatheter aortic valve implantation (TAVI). Pre-procedurally, echocardiography is used to confirm the severity of aortic stenosis, assess the aortic annulus size, exclude contraindications like left ventricular thrombus, and help determine the optimal access route. During TAVI, echocardiography guides valve selection and positioning, identifies complications, and can help address issues like paravalvular regurgitation. Post-procedure, echocardiography is crucial for long-term monitoring of valve function and the detection of any late complications.
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TAVI has become an accepted treatment for severe aortic stenosis, especially in high-risk patients. The PARTNER trial showed non-inferiority of TAVI compared to surgery in high-risk patients, with lower rates of major bleeding and new onset atrial fibrillation for TAVI. A team approach including cardiologists and cardiac surgeons is recommended for optimal patient outcomes with TAVI.
Tavi 2014
This document discusses transcatheter aortic valve implantation (TAVI) for treating severe aortic stenosis. It summarizes several key trials that demonstrated the safety and effectiveness of TAVI compared to surgical aortic valve replacement. The PARTNER trials showed TAVI to be non-inferior to surgery in reducing mortality, while being associated with lower risks of bleeding, stroke, and repeat hospitalization. Subsequent trials like the CoreValve US Pivotal Trial and CHOICE trial reinforced TAVI as a standard treatment for high-risk surgical patients with aortic stenosis.
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Transcatheter aortic valve implantation (TAVI) has been developed as an alternative to surgical aortic valve replacement for high-risk patients. TAVI involves threading a collapsible valve through blood vessels and implanting it to replace the diseased valve. Over 30,000 high-risk patients with severe aortic stenosis have undergone TAVI, based on evidence from studies showing it is safer than surgery for this group. TAVI indications may expand as longer-term data on outcomes becomes available and the procedure requires a multidisciplinary team approach and dedicated training.
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1. Endovascular techniques are increasingly being used to treat aortic pathologies like aneurysms and dissections as they can reduce mortality and morbidity compared to open surgery.
2. However, many challenging cases involve the ascending aorta and aortic arch, which are still difficult to treat using endovascular methods alone due to anatomical constraints.
3. Hybrid procedures combining endovascular and open surgical techniques show promise for expanding the applications of endovascular therapy in complex cases, with extra-anatomic bypass grafts and branches helping to create adequate landing zones for endografts.
T evar
in endo era. aortic is one of the industrial driven medical proedure & one of the most expensive. Its morbidity are quoet acceptable, but......... surgeon if the best deal behind this awsome techno
STEP BY STEP VALVE IN VALVE TMVR
This document describes the step-by-step procedure for transseptal valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) using an Edwards SAPIEN 3 valve. Key steps include patient selection and imaging to assess risk of left ventricular outflow tract obstruction, transseptal puncture to access the left atrium, valve deployment under rapid pacing, and closure of the septal defect if needed. ViV-TMVR provides an alternative to repeat surgery for high-risk patients with a failing bioprosthetic mitral valve. The major risk is left ventricular outflow tract obstruction, which techniques like alcohol septal ablation aim to prevent.
TAVI. What’s next? by Dr Susanna Price
The prevalence of degenerative valvular disease is increasing in the context of an increasingly ageing population, and despite advances in medical and surgical interventions, is associated with a significantly worse outcome when compared with the general population. Data from the EuroHeart Survey (2003) suggests the commonest relates to native valve disease (predominantly aortic stenosis) however, more than one quarter of patients with valve disease have undergone a previous intervention. According to current guidelines, in general treatment for severe, symptomatic aortic stenosis is surgical aortic valve replacement, which is associated with excellent outcomes, however, despite this around 30% of such patients do not undergo surgical intervention.
The last decade has seen a significant change in the potential therapeutic options for patients with aortic valve disease due to the development of transcatheter techniques for valve implantation. Patented in 1991, the first successful human implant of a transcatheter aortic valve was undertaken in 2002, with currently >500,000 implantations having been undertaken in >70 countries worldwide. The evidence supporting transcatheter aortic valve implantation (TAVI) otherwise known as transcatheter aortic valve replacement (TAVR) came originally from the key PARTNER studies, where patients judged to have inoperable aortic stenosis who underwent TAVI having improved survival and a reduction in hospital admission at 1 year. Following the early safety and efficacy studies, and following increasing recommendations for TAVI as an option for patients at high risk in international guidelines, the use of transcatheter techniques is extending to those of lower risk.
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This document discusses abdominal aortic aneurysms (AAAs) and their endovascular repair (EVAR). It defines AAAs as a dilatation of the abdominal aorta over 3cm in diameter. EVAR involves inserting a folded graft through the femoral artery which expands to exclude the aneurysm sac from blood flow and pressure. The benefits of EVAR over open repair include lower peri-operative mortality and complications. Proper patient assessment including vascular anatomy and medical comorbidities is important for determining candidacy for EVAR. The procedure involves deploying graft components in the aorta and iliac arteries under imaging guidance. Post-operative surveillance with imaging is needed to monitor for complications like endoleaks.
Hybrid repair of Thoracoabdominal Aneurysm
1. Classifications and treatment options for thoracoabdominal aortic aneurysms (TAAAs) are discussed, including open repair, endovascular repair (TEVAR), and hybrid procedures combining open and endovascular techniques.
2. Complications of open TAAA repair can include ischemia-induced injury to organs and spinal cord paralysis, while endovascular options may reduce blood loss, stress response, and recovery time.
3. Hybrid procedures involving surgical debranching of visceral arteries combined with TEVAR can benefit high-risk patients and provide alternatives to open repair, with lower reported complications and mortality compared to open surgery.
Endovascular Aortic Aneurysm Repair
The document discusses endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. It presents a case of a 62-year-old male undergoing EVAR for a 5.5cm AAA. EVAR involves deploying a graft via catheter to exclude the aneurysm from blood flow. Complications can include endoleaks, where blood leaks outside the graft but within the aneurysm sac. The main types of endoleaks are type I (inadequate seal at graft ends), type II (collaterals inside the sac), and type III (graft component disruption). EVAR has advantages over open repair like less invasiveness but risks like increased reintervention rates.
Evaluation of prosthetic valve function and clinical utility.
Many of the prosthesis-related complications can be prevented or their impact minimized through optimal prosthesis selection in the individual patient and careful medical management and follow-up after implantation.
Mitra clip
1. The document describes the MitraClip procedure for percutaneous mitral valve repair.
2. The MitraClip procedure involves inserting a clip via the femoral vein to grasp and repair the mitral valve leaflets in a technique similar to the surgical Alfieri repair.
3. The key steps involve transseptal puncture, advancing the clip delivery system into the left atrium, positioning the clip below the mitral valve, grasping the leaflets with the clip, and releasing the clip to create a double orifice mitral valve.
Tevar for the ruptured aneurysms
This document reviews endovascular repair (TEVAR) for ruptured thoracic aortic aneurysms. It provides data on the incidence, mortality rates, and management of ruptured thoracic aneurysms. Open surgical intervention has mortality rates of 18-27% while TEVAR has shown lower 30-day mortality rates of 11-17% in single-institution studies. However, TEVAR is associated with higher mortality risks in older patients (>75 years old) and those with hemodynamic instability. The document recommends TEVAR as a less invasive alternative to open surgery for ruptured thoracic aneurysms, particularly when performed at experienced centers.
Presentation on heart valve devices
This document discusses various percutaneous interventions for structural heart diseases including atrial septal defect (ASD), ventricular septal defect (VSD), patent ductus arteriosus (PDA), sinus of Valsalva aneurysm, and paravalvular leaks. It describes current device closure options like the Amplatzer occluder and the techniques used for percutaneous closure of different defects as well as the advantages over open heart surgery. Complications of device closure are also mentioned.
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PCI & AimRadial 2018 | Safety and Feasibility of Trans-radial Access for Non-...
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IMAGES OF A COMPLEX CASE OF MULTIPLE ANEURYSMAL DISEASE IN A 58 YEAR OLD MAN
IMMAGINI DI UN CASO COMPLESSO DI MALATTIA POLINEURISMATICA
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
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This document discusses techniques for vascular access, focusing on percutaneous femoral artery puncture and radial artery catheterization. It describes:
- Assessing the femoral artery by palpating for pulse and using fluoroscopy to verify the puncture site. The needle is advanced at a 30 degree angle to puncture only the front wall of the artery.
- The femoral vein is located medial to the femoral artery and punctured similarly, though venous pressure is low so back bleeding may be difficult to detect without aspiration.
- Radial artery catheterization has advantages like easy access and hemostasis. It is performed like femoral artery puncture over the radial pulse on the wrist. Vasodilators may be needed to prevent
techniques of vascular access.ppsx
This document discusses techniques for vascular access, focusing on percutaneous femoral artery puncture and radial artery catheterization. It describes:
- Assessing the femoral artery by palpating for pulse and using fluoroscopy to verify the puncture site. The needle is advanced at a 30 degree angle to puncture only the front wall of the artery.
- The femoral vein is located medial to the femoral artery and punctured similarly, though venous pressure is low so back bleeding may be difficult to detect without aspiration.
- Radial artery catheterization has advantages like easy access and hemostasis. It is performed like femoral artery puncture over the radial pulse on the wrist. Vasodilators may be needed to prevent
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Transcaval Retrograde Transcatheter Aortic Valve Replacement for Patients Wit...
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This letter reports on a novel technique for transcatheter aortic valve replacement (TAVR) called transcaval retrograde TAVR. The technique involves using a guidewire to create an arteriovenous fistula between the inferior vena cava and the aorta, allowing access from the femoral vein. It was successfully performed in 4 inoperable patients with severe aortic stenosis who were not suitable candidates for standard approaches. All procedures were completed safely without complications. This new caval-aortic approach avoids femoral arterial complications and may expand treatment options for patients without other access routes.Diagnostic procedure of dsa and management of its
This document provides information on diagnostic cerebral angiography procedures and managing complications. It begins with a brief history and overview, then discusses indications, materials, and steps for the procedure. Potential neurological complications discussed include ischemic stroke, transient global amnesia, cortical blindness, and aneurysm rupture. Risk factors and treatments for complications are outlined. Non-neurological complications like hematoma, pseudoaneurysm, and contrast-induced nephropathy are also summarized. The document provides detailed information on performing angiography safely and managing various potential issues.
Heart care
This document provides information on various cardiac procedures including:
- Coronary angiography and angioplasty/stenting to open blocked arteries
- Balloon valvuloplasty to widen a narrowed heart valve
- Pacemaker implantation
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It describes what happens before, during, and after these procedures, including potential risks, recovery process, and lifestyle changes needed for cardiac health.
Video assisted thoracic surgery
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1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
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1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
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- 2. Aortic valve replacement Refused for Surgery Euro Heart Survey on Valvular Heart Disease (5001 Patients) 32 % did not undergo surgery ! Iung B. and al, Eur. Heart Journal 2003 : 24, 1231-1243 But cardiologists never lose the hope Interventional Cardiology „Credo‟ “Anything a cardiac surgeon can do, an interventional cardiologist can do as well or better percutaneously” AH Gershlick, 2003
- 3. First human implantation: Alain Cribier April 16, 2002 ( France) Bovine pericardium valve 23mm in diameter
- 8. • Vascular access – Sites • Transfemoral • Transapical – – – – Left ant. thoracotomy More direct, shorter catheter Septal hypertrophy Ascendra2, Sapien valve • Transaortic – – – – – Upper partial sternotomy Mini-sternotomy 2/3 RICS Aorta 5 cm above valve Less painful, familiar approach Manipulation of ascending aorta • Subclavian Percutaneous or Cut-down technique
- 11. “Feasibility trial” reports deployment of new device for TAVI in aortic insufficiency 23 May 2013, Paris, France: A new investigational device - the Helio System (TF-FA) - being developed for use with the Sapien XT Transcatheter Heart Valve was successfully deployed in all four patients in a small, first-in-human feasibility study of its use in high-risk aortic insufficiency reported at EuroPCR 2013. there were no in-hospital deaths. One patient had a stroke/TIA and one suffered minor vascular complication. One patient, who had preexisting renal impairment, had an acute kidney injury. The primary endpoint of freedom from all-cause mortality at 30 days was 100% all four patients were alive at one year. Aortic insufficiency improved from moderate to severe before the procedure to trivial at 30 days. Two patients followed up at 12 months had no aortic insufficiency at this time point.