Trans aortic tavi
•
4 likes•2,714 views
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.
Report
Share
Report
Share
Download to read offline
Recommended
TAVI between dreams and reality
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.
TAVI procedure review with cases
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.
TAVI - Transcatheter Aortic Valve Implantation
An extensive presentation on the upcoming catheter based aortic valve implantation including a future perspective of TAVI
TAVI
The document provides an overview of transcatheter aortic valve implantation (TAVI), including a brief history of its development, descriptions of the Edwards Sapien valve and delivery systems, approaches for TAVI, and complications. It also discusses patient screening and risk stratification, as well as newer valve devices that are being developed.
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
Clinical needs finding presentation tavi
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.
Transcatheter Aortic Valve Replacement (TAVR): Established and Emerging Indic...
By Paul Sorajja, MD. The efficacy and safety of transcatheter valve replacement in high-risk, non-operable patients is leading to new valve therapy options for a broader pateint population. "The options we have today to fix problems without opening the chest would have been unimaginable 10 years ago."
TAVI
Review the concept of TAVI
Evaluation of patients considered for TAVI
Review of evidence
Identify future applications
Recommended
TAVI between dreams and reality
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.
TAVI procedure review with cases
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.
TAVI - Transcatheter Aortic Valve Implantation
An extensive presentation on the upcoming catheter based aortic valve implantation including a future perspective of TAVI
TAVI
The document provides an overview of transcatheter aortic valve implantation (TAVI), including a brief history of its development, descriptions of the Edwards Sapien valve and delivery systems, approaches for TAVI, and complications. It also discusses patient screening and risk stratification, as well as newer valve devices that are being developed.
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
Clinical needs finding presentation tavi
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.
Transcatheter Aortic Valve Replacement (TAVR): Established and Emerging Indic...
By Paul Sorajja, MD. The efficacy and safety of transcatheter valve replacement in high-risk, non-operable patients is leading to new valve therapy options for a broader pateint population. "The options we have today to fix problems without opening the chest would have been unimaginable 10 years ago."
TAVI
Review the concept of TAVI
Evaluation of patients considered for TAVI
Review of evidence
Identify future applications
Echocardiography in TAVI patients 2014
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.
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.
TRIAL EVIDENCE OF TAVI
DETAILS OF EVIDENCE TAVI FROM ITS EXISTENCE IN INTERVENTIONAL CARDIOLOGY TO THE SURTAVI REGISTRY ..AS AN OPTION FROM HIGH RISK UNOPERABLE PATIENTS TO INTERMEDIATE AND LOW RISK PATIENTS
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.
Diethrich Sweden
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.
J. frederick ctsa summit tavr
Dr. John Frederik presents "CTSA Summit TAVR" at the March 4 -6, 2016 Cardiac and Thoracic Surgery Associates, Cardiovascular Summit at The Westin Riverfront Resort and Spa.
Transcatheter therapy for Mitral Regurgitation (MR)
The document discusses transcatheter therapy for mitral regurgitation. It describes the anatomy of the mitral valve and causes of mitral regurgitation. Surgical repair or replacement is the standard treatment but some high-risk patients are not candidates. The MitraClip procedure is described which uses a percutaneous clip to grasp the leaflets and reduce regurgitation as a less invasive alternative for selected patients. Effectiveness has been demonstrated in clinical trials but long-term outcomes are still being evaluated.
Endovascular Repair of Thoracoabdominal Aneurysm
This document discusses total endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) using fenestrated and branched endovascular aneurysm repair (F-EVAR/B-EVAR) techniques. It summarizes outcomes from 86 high-risk patients treated with F-EVAR/B-EVAR for TAAA between 2007-2014, finding a 30-day mortality of 2.3%, 1-year survival of 91%, and 3-year survival of 88%. The use of staged procedures was associated with reducing spinal cord ischemia from 10% to 0%. The conclusion is that F-EVAR/B-EVAR provides good outcomes for high-risk TAAA patients when
Tavi,Transcatheter Aortic Valve Replacement, TAVI,TAVR,
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.
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.
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.
EVAR - Nicola Tanner
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.
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.
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.
The expanding clinical applications of tevar
The document summarizes the expanding clinical applications of endovascular aneurysm repair (TEVAR) beyond its original use for descending thoracic aneurysms. It discusses how TEVAR is now being used to treat a wider range of thoracic aortic pathologies including dissections, ulcers, trauma, and various complex aneurysms. The document also explores new techniques like branched endografts and debranching procedures that are pushing the anatomic limits of TEVAR proximally and distally. While noting some limitations, it presents data showing TEVAR has led to reduced mortality, complications, and hospital stay compared to open surgery for many thoracic aortic conditions.
Ivancev 2
The document discusses fenestrated endovascular aneurysm repair (FEVAR) for juxtarenal abdominal aortic aneurysms. It summarizes studies comparing outcomes of open surgery, FEVAR, and chimney EVAR. FEVAR had lower mortality and complications than open surgery. The Zenith Fenestrated graft and a new preloaded P-Branch device were presented. The P-Branch aims to improve precision and reduce planning/production time but may have limitations from imperfect vessel alignment. Overall, FEVAR improves outcomes over open repair for juxtarenal aneurysms.
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.
Tavi 3
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.
Challenges of Radial Access-Anatomy, Tools and Success
The document discusses some of the challenges of the transradial approach for coronary procedures. It notes that anatomical variations can occur in around 23% of cases, including radial artery tortuosity, stenosis, hypoplasia, and abnormal origins. Success rates for transradial procedures range from 83-96.7%, but can be lower for certain variations like arteria lusoria. It also discusses techniques for overcoming challenges like vascular loops and spasm, and notes there is a learning curve associated with the transradial approach.
Hybrid approach for type a aortic dissection
1. This document discusses surgical approaches for treating type A aortic dissection, including a hybrid approach combining surgery and stenting.
2. It presents two clinical cases where different surgical strategies were used - a multibranched frozen elephant trunk procedure and a two-step approach combining ascending-arch repair with later TEVAR.
3. The key decision points for surgical treatment are the clinical presentation, site of the intimal tear, and patient age, and the document advocates for extensive aortic repair to prevent chronic enlargement of the false lumen and further complications.
Tricuspid interventions
The document summarizes recent developments in transcatheter interventions for tricuspid valve disease. It describes various devices that have been developed to address tricuspid regurgitation through approaches such as leaflet repair, annuloplasty, and valve replacement. Clinical trials of devices like the MitraClip, Trialign, and TriCinch show promise in reducing regurgitation and improving symptoms, though longer-term outcomes remain to be seen. Ongoing research aims to optimize patient selection and develop new technologies for treating different failure mechanisms of the tricuspid valve.
More Related Content
What's hot
Echocardiography in TAVI patients 2014
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.
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.
TRIAL EVIDENCE OF TAVI
DETAILS OF EVIDENCE TAVI FROM ITS EXISTENCE IN INTERVENTIONAL CARDIOLOGY TO THE SURTAVI REGISTRY ..AS AN OPTION FROM HIGH RISK UNOPERABLE PATIENTS TO INTERMEDIATE AND LOW RISK PATIENTS
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.
Diethrich Sweden
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.
J. frederick ctsa summit tavr
Dr. John Frederik presents "CTSA Summit TAVR" at the March 4 -6, 2016 Cardiac and Thoracic Surgery Associates, Cardiovascular Summit at The Westin Riverfront Resort and Spa.
Transcatheter therapy for Mitral Regurgitation (MR)
The document discusses transcatheter therapy for mitral regurgitation. It describes the anatomy of the mitral valve and causes of mitral regurgitation. Surgical repair or replacement is the standard treatment but some high-risk patients are not candidates. The MitraClip procedure is described which uses a percutaneous clip to grasp the leaflets and reduce regurgitation as a less invasive alternative for selected patients. Effectiveness has been demonstrated in clinical trials but long-term outcomes are still being evaluated.
Endovascular Repair of Thoracoabdominal Aneurysm
This document discusses total endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) using fenestrated and branched endovascular aneurysm repair (F-EVAR/B-EVAR) techniques. It summarizes outcomes from 86 high-risk patients treated with F-EVAR/B-EVAR for TAAA between 2007-2014, finding a 30-day mortality of 2.3%, 1-year survival of 91%, and 3-year survival of 88%. The use of staged procedures was associated with reducing spinal cord ischemia from 10% to 0%. The conclusion is that F-EVAR/B-EVAR provides good outcomes for high-risk TAAA patients when
Tavi,Transcatheter Aortic Valve Replacement, TAVI,TAVR,
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.
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.
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.
EVAR - Nicola Tanner
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.
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.
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.
The expanding clinical applications of tevar
The document summarizes the expanding clinical applications of endovascular aneurysm repair (TEVAR) beyond its original use for descending thoracic aneurysms. It discusses how TEVAR is now being used to treat a wider range of thoracic aortic pathologies including dissections, ulcers, trauma, and various complex aneurysms. The document also explores new techniques like branched endografts and debranching procedures that are pushing the anatomic limits of TEVAR proximally and distally. While noting some limitations, it presents data showing TEVAR has led to reduced mortality, complications, and hospital stay compared to open surgery for many thoracic aortic conditions.
Ivancev 2
The document discusses fenestrated endovascular aneurysm repair (FEVAR) for juxtarenal abdominal aortic aneurysms. It summarizes studies comparing outcomes of open surgery, FEVAR, and chimney EVAR. FEVAR had lower mortality and complications than open surgery. The Zenith Fenestrated graft and a new preloaded P-Branch device were presented. The P-Branch aims to improve precision and reduce planning/production time but may have limitations from imperfect vessel alignment. Overall, FEVAR improves outcomes over open repair for juxtarenal aneurysms.
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.
Tavi 3
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.
Challenges of Radial Access-Anatomy, Tools and Success
The document discusses some of the challenges of the transradial approach for coronary procedures. It notes that anatomical variations can occur in around 23% of cases, including radial artery tortuosity, stenosis, hypoplasia, and abnormal origins. Success rates for transradial procedures range from 83-96.7%, but can be lower for certain variations like arteria lusoria. It also discusses techniques for overcoming challenges like vascular loops and spasm, and notes there is a learning curve associated with the transradial approach.
What's hot (20)
PERCUTANEOUS TREATMENT STRATEGIES OF VALVULAR HEART DISEASE
PERCUTANEOUS TREATMENT STRATEGIES OF VALVULAR HEART DISEASE
Transcatheter therapy for Mitral Regurgitation (MR)
Transcatheter therapy for Mitral Regurgitation (MR)
Tavi,Transcatheter Aortic Valve Replacement, TAVI,TAVR,
Tavi,Transcatheter Aortic Valve Replacement, TAVI,TAVR,
Challenges of Radial Access-Anatomy, Tools and Success
Challenges of Radial Access-Anatomy, Tools and Success
Similar to Trans aortic tavi
Hybrid approach for type a aortic dissection
1. This document discusses surgical approaches for treating type A aortic dissection, including a hybrid approach combining surgery and stenting.
2. It presents two clinical cases where different surgical strategies were used - a multibranched frozen elephant trunk procedure and a two-step approach combining ascending-arch repair with later TEVAR.
3. The key decision points for surgical treatment are the clinical presentation, site of the intimal tear, and patient age, and the document advocates for extensive aortic repair to prevent chronic enlargement of the false lumen and further complications.
Tricuspid interventions
The document summarizes recent developments in transcatheter interventions for tricuspid valve disease. It describes various devices that have been developed to address tricuspid regurgitation through approaches such as leaflet repair, annuloplasty, and valve replacement. Clinical trials of devices like the MitraClip, Trialign, and TriCinch show promise in reducing regurgitation and improving symptoms, though longer-term outcomes remain to be seen. Ongoing research aims to optimize patient selection and develop new technologies for treating different failure mechanisms of the tricuspid valve.
Tavi 3
The document discusses transcatheter aortic valve implantation (TAVI), including its approval and increasing use in Europe and the United States. It provides details on the team approach, devices, procedures, outcomes, and complications of TAVI based on clinical trials such as PARTNER. TAVI is an alternative to surgical aortic valve replacement for high-risk or inoperable patients with severe aortic stenosis.
Mitral valve surgical treatment
The document describes various surgical approaches for acquired mitral valve disease. It discusses considerations for mitral valve repair versus replacement and emphasizes the importance of surgeon experience for complex repairs. Standard median sternotomy is described as the most common approach, while minimally invasive approaches through smaller incisions are also discussed. Specific techniques for exposing the mitral valve through the right atrium, interatrial groove, or left atrial dome are outlined. Factors such as concomitant procedures, myocardial protection, and closure are addressed.
CTO-- TEN COMMANDMENTS
CTO PCI will mostly benefit patients who have angina refractory to optimal medical management and those with large ischemic burden
Care of CVP line .pptx
This document provides information about central venous catheters and PICC lines, including their indications, contraindications, anatomy, insertion procedures, complications, and care. It discusses the internal jugular, subclavian, and femoral vein access sites and provides details on the Seldinger technique for catheter insertion. The roles of nurses in central line care including dressing changes, flushing, and preventing infections are also covered.
Brachio Femoral Loop Our Experience
BRACHIO-FEMORAL LOOP AND CABLE TECHNIQUE FOR EVAR: a way out which allows the device to advance with ease, consenting a more
precise releasing of the endograft main body and positioning of the prosthetic
contralateral leg
ACCESSO BRACHIO FEMORALE E TECNICA DELLA FUNIVIA: soluzione che permette all'introduttore di avanzare facilmente e consente un rilascio più preciso del corpo principale dell'endoprotesi ed il posizionamento della gambetta controlaterale
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
Catheter tip positioning control in chest port implantation. Luc Rotenberg 2018
Catheter tip positioning control in chest port implantation.
Fluoroscopy ans XRay control vs ECG control
Luc Rotenberg
Johannesburg Oct 2018
Tevar
This document discusses surgical techniques for debranching the aortic arch in hybrid procedures to treat aortic arch aneurysms. It describes how open surgery is used to reroute blood flow from the supra-aortic vessels before placing an endograft. Various zones of the aortic arch are defined based on the vessels involved, and the specific bypass procedures for each zone are outlined. The hybrid approach aims to reduce risks compared to open surgery alone by combining debranching with endovascular exclusion of the aneurysm. While outcomes are promising, mortality and morbidity rates are still significant and patient fitness must be considered.
Radial artery access ,complications and magement
1. Radial artery access is an alternative to femoral artery access for coronary procedures that offers advantages like lower bleeding risks and faster recovery times.
2. The radial artery anatomy and variations like tortuosity must be considered to select appropriate patients and techniques.
3. Radial artery puncture and navigation of wires and catheters through the arm requires specialized techniques to prevent complications like spasm or dissection.
4. Maintaining radial artery patency with anticoagulation, proper compression, and monitoring is important to prevent radial artery occlusion following the procedure.
Vascular Access Part 1: Reducing risk and increasing catheter longevity
Vascular access is essential for critically ill patients in the ICU. Nearly all patients will require some form of vascular device such as a PIVC, PICC, or CVC. While necessary, these devices carry risks of complications and infection if not inserted and managed properly. The document emphasizes that insertion is only a small part of device management, and more attention needs to be paid to the 99% of time the device is in use. It provides recommendations for proper device selection, insertion technique including use of ultrasound and micro-puncture, dressing and securement, and tip location to reduce risks and improve device longevity during the critical care stay.
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
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.
Transcatheter therapy for mitral regurgitation
Trans catheter intervention is emerging field in cardiac intervention. due to complex anatomy of mitral valve understanding of anatomy and three dimensional imaging is most important aspect of successful intervention and could be life saving in high risk surgical candidate
Central venous catheterisation
Central venous catheters are inserted into central veins to deliver fluids, medications, or monitor central venous pressure. The three main sites for central venous catheter placement are the internal jugular, subclavian, and femoral veins. Potential complications include hemorrhage, pneumothorax, and guidewire entanglement. Care must be taken to inspect guidewires and hold them securely during insertion and removal to avoid complications.
Video assisted thoracic surgery (vats)
1. Video-assisted thoracoscopic surgery (VATS) is a minimally invasive procedure used to diagnose and treat illnesses of the lungs and chest cavity.
2. VATS involves making small incisions and inserting surgical instruments and a camera to allow the surgeon to see inside the chest. This avoids the need for large incisions.
3. VATS is used for procedures like lung biopsies, removal of parts of the lung, treatment of collapsed lungs, and draining fluid from the chest cavity. It offers benefits like less pain, shorter recovery time, and smaller scars compared to traditional open chest surgery.
TEVAR for ATAA with Minimalist Approach
This document summarizes a case study of a 79-year-old male patient who underwent an endovascular repair of an ascending thoracic aortic aneurysm (ATAA) under local anesthesia and conscious sedation. The patient had multiple comorbidities that made him high risk for open surgery. Under fluoroscopy guidance, two stent grafts were deployed via a percutaneous approach to exclude the aneurysm. The procedure was successful with no complications and the patient was discharged the next day. This case demonstrates that endovascular repair of ATAA with local anesthesia is feasible and could be an alternative to open surgery for high-risk patients.
ECHOCARDIOGRAPHY IN INTERVENTIONS
This document discusses the use of echocardiography to guide percutaneous interventions involving the mitral valve, including:
1. Percutaneous balloon mitral valvuloplasty to treat mitral stenosis, assessing valve anatomy and suitability.
2. Edge-to-edge repair with the Mitraclip device to treat mitral regurgitation, including patient selection, valve assessment, and guidance during the procedure.
3. Closure of prosthetic paravalvular mitral leaks, with echocardiography used for assessment, guidance, and monitoring complications.
А.Г. Осиев "Техники реканализации хронических окклюзий коронарных артерий"
The document discusses techniques for recanalizing chronic total occlusions (CTOs) in coronary arteries. It provides an overview of success rates for CTO recanalization, which range from 65-79%. It also describes various antegrade and retrograde wire techniques used to recanalize CTOs including parallel wire techniques, side branch techniques, subintimal re-entry techniques, and the controlled antegrade and retrograde subintimal tracking (CART) technique. More recently, devices like the Crosser system and Spectranetics have been developed to aid in CTO recanalization.
Similar to Trans aortic tavi (20)
Catheter tip positioning control in chest port implantation. Luc Rotenberg 2018
Catheter tip positioning control in chest port implantation. Luc Rotenberg 2018
Vascular Access Part 1: Reducing risk and increasing catheter longevity
Vascular Access Part 1: Reducing risk and increasing catheter longevity
А.Г. Осиев "Техники реканализации хронических окклюзий коронарных артерий"
А.Г. Осиев "Техники реканализации хронических окклюзий коронарных артерий"
Recently uploaded
share - Lions, tigers, AI and health misinformation, oh my!.pptx
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Efficacy of Avartana Sneha in Ayurveda
Avartana Sneha is a unique method of Preparation of Sneha Kalpana in Ayurveda, mainly it is indicated for the Vataja rogas.
Journal Article Review on Rasamanikya
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
The Electrocardiogram - Physiologic Principles
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
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
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
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
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NARCOTICS- POLICY AND PROCEDURES FOR ITS USE
This document outlines policies and procedures for handling narcotic and controlled drugs in NABH accredited hospitals.
pathology MCQS introduction to pathology general pathology
pathology MCQS introduction to pathology general pathology
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Role of Mukta Pishti in the Management of Hyperthyroidism
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
It includes regulation of combination products and medical devices. FDA and industry liaisons.
Adhd Medication Shortage Uk - trinexpharmacy.com
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
All info about Diabetes and how to control it.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Recently uploaded (20)
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
share - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptx
Tests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptx
pathology MCQS introduction to pathology general pathology
pathology MCQS introduction to pathology general pathology
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdf
Role of Mukta Pishti in the Management of Hyperthyroidism
Role of Mukta Pishti in the Management of Hyperthyroidism
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Outbreak management including quarantine, isolation, contact.pptx
Outbreak management including quarantine, isolation, contact.pptx
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
Trans aortic tavi
- 1. Transaortic aortic valve implantation with Sapien Gian Luca Martinelli MD CV Surgery Dept. S Anna Hospital – Catanzaro - Italy
- 2. VASCULAR ACCESS Transsubclavian Transaortic Transapical Transfemoral
- 5. TA - AVI
- 6. ALTERNATIVE APPROACHES • Transsubclavian (generally left) • Transaortic: two options Minimal anterior thoracotomy Upper ministernotomy
- 7. CLINICAL PRESENTATION 81 yo female NYHA III Good EF, severe aortic stenosis Chronic pulmonary disease in medical treatment, cerebral and peripherical vascular disease LogisticEuroScore 28%, EuroScore II 6%, STS score 7%
- 8. ECHOCARDIOGRAM EF 45%, functional area 0,75 cm2, mean gradient 40 mmhg, peak velocity > 4 m/sec
- 10. MSCT SCAN
- 11. CHOICE OF MINISTERNOTOMY Conventional approach, TF- AVI or TA-AVI, was not desirable AND the ascending aorta was deemed suitable for conventional cannulation
- 12. STEP BY STEP PROCEDURE A 5 cm J-shaped upper ministernotomy; A 8-Fr sheath insertion through a double pledgets reinforced purse string sutures with the Seldinger technique; Crossing aortic valve with a straight wire supported by a right Judkins catheter; Insertion of a pre-shaping super stiff guide wire in left ventricle; Finally the Ascendra 2 transapical delivery system is introduced through the aorta and kept in its upper part.
- 13. IDEAL STAIGHT LINE FOR OPTIMAL VALVE RELEASE • A non-calcified area on the ascending aorta was identified which would allow direction of the sheath in a STRAIGHT LINE to deploy the device, leaving enough space between the Ascendra system and the device itself.
- 15. VALVE RELEASE
- 16. AORTIC ANGIOGRAM AND ECHOCARDIOGRAM CONTROL
- 17. THE DAY AFTER • RX TORACE
- 18. LESSON LEARNED • Procedural success: adequate technical placement, normal bioproshesis performance and recovery; • Advantage: overcoming challenging aorto-ileo – femoral-vascular disease, avoid arch crossing and new left ventricular scar; • The proximity between the puncture site and the native aortic valve allows easier manipulation and delivery of the device, with an IDEAL straight line.
- 19. CONCLUSIONS • Upper ministernotomy represent an additional option for patients who are NOT candidates for TF-AVI and in whom an apical approach may represent a less desirable option (low EF, severe pulmonary disfunction); • Access to arterial brachiocephalic trunk is also avaible through this incision; • Controindication for transaortic TAo-AVI approach: porcelain aorta.