Διδάγγελος Ματθαίος

Ειδικευόμενος Καρδιολογίας

Α’ Πανεπιστημιακή Καρδιολογική Κλινική

Π.Γ.Ν.Θ. ΑΧΕΠΑ

Θεσσαλονίκη

Conflicts of interest:

None

What is TAVI?

TAVΙ/TAVR

• Transcatheter Aortic Valve Implantation

• Transcatheter Aortic Valve Replacement

History

TAVI history

2002: 1st TAVI - Alain Cribier

2010: 1st randomized trial - PARTNER 1B

2017: >200,000 valves implanted globally

Cribier A. et al. Circulation. 2002;106(24):3006-8.

1st TAVI - 2002

PARTNER 1B - 2010 - inoperable patients

US Core Valve - 2014

High risk: STS > 15%

PARTNER 2 - 2016

SURTAVI - 2017

Intermediate risk: STS = 4-8%

SURTAVI

NOTION - 2015

Low risk: STS < 4%

Guidelines

TAVI

guidelines

ESC 2017

ESC Guidelines Valvular Heart Disease 2017

TAVI guidelines ESC 2017

ESC Guidelines Valvular Heart Disease 2017

TAVI guidelines AHA/ACC 2017

2017 Focused Update AHA/ACC Valvular Heart Disease

Patient selection

TAVI checklist

Clinical Anatomical

Otto CM et al. ACC Expert Consensus TAVI 2017. JACC 2017;69(10):1313-1346.

TAVI checklist

Otto CM et al. ACC Expert Consensus TAVI 2017. JACC 2017;69(10):1313-1346.

TAVI checklist

Otto CM et al. ACC Expert Consensus TAVI 2017. JACC 2017;69(10):1313-1346.

TAVI checklist

Frailty

• A common and important geriatric syndrome characterized by age-

associated declines in physiologic reserve and function across multi-organ

systems, leading to increased vulnerability for adverse health outcomes.

FRAIL scale (0=best, 5=worst)

Fatigue

Resistance

Ambulation

Illnesses

Loss of weight

Frail=3-5

Pre-frail=1-2

Healthy=0

Morley JE et al. J Nutr Health Aging. 2012;16(7):601-8.

Otto CM et al. ACC Expert Consensus TAVI 2017. JACC 2017;69(10):1313-1346.

TAVI checklist

Risk scores

Low Intermediate High

STS-PROM <4% 4-8% >8% (>10%)

EuroSCORE II <4% 4-10% >10%

EuroSCORE I <10% 10-20% >20%

STS score

EuroSCORE II

EuroSCORE I (logistic)

Risk assessment AHA/ACC 2014

2014 AHA/ACC Valvular Heart Disease Guidelines

TAVI multi-imaging parameter

assessment

Cocchia R et al. World J Cardiol 2017;9(3):212-229.

TAVI multi-imaging parameter

assessment

Cocchia R et al. World J Cardiol 2017;9(3):212-229.

min diameter >6mm

Otto CM et al. ACC Expert Consensus TAVI 2017. JACC 2017;69(10):1313-1346.

TAVI checklist

Choice of intervention

ESC Guidelines Valvular Heart Disease 2017

Choice of intervention

ESC Guidelines Valvular Heart Disease 2017

Choice of intervention

ESC Guidelines Valvular Heart Disease 2017

TAVI contra-indications

Cocchia R et al. World J Cardiol 2017;9(3):212-229.

Take-home messages

• TAVI is an option for severe symptomatic AoS in (always

confirmed by a Heart-Team):

– Inoperable patients

– High surgical risk patients

– Intermediate surgical risk patients

• Carefully select patients based on:

– Clinical and

– Anatomical characteristics

References

TAVI decision

pathway

Otto CM et al. ACC Expert Consensus TAVI 2017. JACC 2017;69(10):1313-1346.

TAVI Guidelines AHA/ACC

2017 Focused Update AHA/ACC Valvular Heart Disease

TAVI Guidelines AHA/ACC

2017 Focused Update AHA/ACC Valvular Heart Disease

TAVI Guidelines AHA/ACC

2017 Focused Update AHA/ACC Valvular Heart Disease

TAVI Guidelines AHA/ACC

2017 Focused Update AHA/ACC Valvular Heart Disease

WRITTEN Worldwide TAVI registry 2017