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

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

Page 1: What is TAVI? · ESC Guidelines Valvular Heart Disease 2017. TAVI guidelines ESC 2017 ... Risk assessment AHA/ACC 2014 2014 AHA/ACC Valvular Heart Disease Guidelines. TAVI multi-imaging

Διδάγγελος Ματθαίος

Ειδικευόμενος Καρδιολογίας

Α’ Πανεπιστημιακή Καρδιολογική Κλινική

Π.Γ.Ν.Θ. ΑΧΕΠΑ

Θεσσαλονίκη

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Conflicts of interest:

None

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What is TAVI?

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TAVΙ/TAVR

• Transcatheter Aortic Valve Implantation

• Transcatheter Aortic Valve Replacement

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History

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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

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US Core Valve - 2014

High risk: STS > 15%

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PARTNER 2 - 2016

SURTAVI - 2017

Intermediate risk: STS = 4-8%

SURTAVI

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NOTION - 2015

Low risk: STS < 4%

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Guidelines

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TAVI

guidelines

ESC 2017

ESC Guidelines Valvular Heart Disease 2017

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TAVI guidelines ESC 2017

ESC Guidelines Valvular Heart Disease 2017

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TAVI guidelines AHA/ACC 2017

2017 Focused Update AHA/ACC Valvular Heart Disease

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Patient selection

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TAVI checklist

Clinical Anatomical

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

TAVI checklist

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

TAVI checklist

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

TAVI checklist

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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.

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

TAVI checklist

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Risk scores

Low Intermediate High

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

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

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

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STS score

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EuroSCORE II

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EuroSCORE I (logistic)

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Risk assessment AHA/ACC 2014

2014 AHA/ACC Valvular Heart Disease Guidelines

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TAVI multi-imaging parameter

assessment

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

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TAVI multi-imaging parameter

assessment

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

min diameter >6mm

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

TAVI checklist

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Choice of intervention

ESC Guidelines Valvular Heart Disease 2017

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Choice of intervention

ESC Guidelines Valvular Heart Disease 2017

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Choice of intervention

ESC Guidelines Valvular Heart Disease 2017

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TAVI contra-indications

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

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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

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References

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TAVI decision

pathway

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

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TAVI Guidelines AHA/ACC

2017 Focused Update AHA/ACC Valvular Heart Disease

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TAVI Guidelines AHA/ACC

2017 Focused Update AHA/ACC Valvular Heart Disease

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TAVI Guidelines AHA/ACC

2017 Focused Update AHA/ACC Valvular Heart Disease

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TAVI Guidelines AHA/ACC

2017 Focused Update AHA/ACC Valvular Heart Disease

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WRITTEN Worldwide TAVI registry 2017

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