TAVI 2017 KERCKHOFF HERZ- UND THORAXZENTRUM > 10 years - - PowerPoint PPT Presentation

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TAVI 2017 KERCKHOFF HERZ- UND THORAXZENTRUM > 10 years - - PowerPoint PPT Presentation

Apr 05, 2023 108 likes •392 views

KERCKHOFF HERZ- UND THORAXZENTRUM The use of TAVI for bioprosthetic aortic valve failure only for high risk patients or an integral component of AS management strategies Prof. Dr. Thomas Walther Kerckhoff HeartCenter, Department Cardiac

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KERCKHOFF HERZ- UND THORAXZENTRUM

The use of TAVI for bioprosthetic aortic valve failure –

  • nly for high risk patients or an integral

component of AS management strategies

  • Prof. Dr. Thomas Walther

Kerckhoff HeartCenter, Department Cardiac Surgery, Bad Nauheim, Germany

no personal financial disclosures

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Recent patient example (06/2017)

▪ s/p AVR (Hancock 23mm) 2007 ▪ 75 years, male, increased risk due to cardiac decompensation and s/p CPR for 30 min. ▪ Acute cardiac failure with severe AI

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Recent patient example (06/2017)

▪ Acute VinV Acurate neo 23mm, TF implant

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Recent patient example (06/2017)

▪ Pmean 11mmHg, uncomplicated further course, extubated 3 hrs later

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TAVI 2017

▪ > 10 years experience, steep increased in patient numbers

Sometimes you don`t know how they got there …

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TAVI risk: Low - Intermediate - high

risks: age

60 70 80 90

e.g. dialysis s/p CABG Low EF Pulmonary hypertension Porcelain aorta Frailty …

Low risk

Valve in Valve

(reoperation – increased risk)

▪ Heart Team Decision:

Technical aspects

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KERCKHOFF HERZ- UND THORAXZENTRUM

VinV

=> straight forward like a penalty kick …

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KERCKHOFF HERZ- UND THORAXZENTRUM

Increasing number of xenograft implants

=> Increasing elderly pts and potential „demand“ for VinV

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The concept of VinV

no sternotomy, no cardioplegic arrest, off-pump

= truely minimally invasive reduced invasiveness of re-do AVR in high risk patients

SAPIEN THV Valve-in-a-Valve (VinV)

+

Degenerated Xenograft

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KERCKHOFF HERZ- UND THORAXZENTRUM

VinV: bench testing

▪ valve size matching

▪ functional performance and migration ▪ hydrodynamic (steady and pulsatile) ▪ accelerated wear

@ Edwards Laboratories, Irvine, CA, USA; M.Dehdashtian and team

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VinV: Experimental studies

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VinV

▪ TAVI in sAVR ▪ TAVI in TAVI (bailout, degeneration, …) ▪ TAVI in MVR,

etc.

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VinV: SAPIEN 23 in Perimount 21

first human transapical VinV implantation 2007, Leipzig

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VinV - Literature

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VinV - aortic

▪ n = 11, age 78 years, log. ES 32% ▪ all successful implants, all off-pump ▪ no paravalvular AI, mild central AI = 2 ▪ mean pressure gradients 11 ±4 mmHg

▪ procedural time 71 min.

▪ F-up 330 days, all well an alive

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VinV: examples in…

Hancock, Mosaic, Epic, Mitroflow

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VinV screening

▪ Type of implanted valve with visualisation (annulus, struts) ▪ Size of implanted degenerated xenogrft ▪ Aortic root anatomy ▪ => selection of suitable TAVI prosthesis: intraannular valve (SAPIEN) or supraannular valve (COREVALVE, ACURATE, etc.)

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VinV -aortic: aortic root imaging !

Pre-OP CT mandatory !

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VinV app (V. Bapat)

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VinV

=> but can also be cumbersome …

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VinV -

therapy of choice in case of decreased TAVI durability

Arsalan M, Walther T: Durability of prostheses for transcatheter aortic valve implantation. Nat Rev Cadiol 2016;13:360-7

Dvir et al, EuroPCR May 2016

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KERCKHOFF HERZ- UND THORAXZENTRUM

AS: increasing use of xenografts /

potential VinV

Risk =>

incremental changes

Age =>

continuous changes 50 60 40 70 30 80 90 20 + AV-Repair / Mechanical valves / (Ross) Xenograft

Conventional / sutureless

T-AVI futile High risk Intermediate risk <= Low risk

Low risk

  • Interm. risk

High risk

  • Log. Euroscore

< 10 10 - 20 > 20

STS Score

< 3 3 - 6 > 8

AKL Score

< 3 3 - 6 > 6

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VinV / VinR mitral

▪ Experimental evaluation 2008 ▪ Nowadays clinical routine.

Consider complex anatomy, LVOT, mitral - aortic angle, etc.

Kempfert, Walther et al: Eur Heart J. 2008;29:2382-7

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Valve in valve (VinV)

▪ Exact screening important, exclude

endocarditis, PV leak, aortic pathology, etc.

▪ Established minimally invasive option for (all) patients with degenerated xenografts ▪ Change in valve selection criteria - lower threshold for xenografts

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KERCKHOFF HERZ- UND THORAXZENTRUM

Thank you !

t.walther@kerckhoff-klinik.de