What is TAVI? · ESC Guidelines Valvular Heart Disease 2017. TAVI guidelines ESC 2017 ... Risk...
Transcript of What is TAVI? · ESC Guidelines Valvular Heart Disease 2017. TAVI guidelines ESC 2017 ... Risk...
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