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

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Διδάγγελος Ματθαίος Ειδικευόμενος Καρδιολογίας Α’ Πανεπιστημιακή Καρδιολογική Κλινική Π.Γ.Ν.Θ. ΑΧΕΠΑ Θεσσαλονίκη

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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)

    FatigueResistance

    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 8% (>10%)

    EuroSCORE II 10%

    EuroSCORE I 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