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Are we ready for expanding TAVI indications to moderate and low risk

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Presentation on theme: "Are we ready for expanding TAVI indications to moderate and low risk"— Presentation transcript:

1 Are we ready for expanding TAVI indications to moderate and low risk
Are we ready for expanding TAVI indications to moderate and low risk? A European perspective Christoph K. Naber Contilia Heart and Vascular Center Elisabeth Krankenhaus Essen Germany

2 Disclosure Statement of Financial Interest
Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the organization(s) listed below. Affiliation/Financial Relationship Company Grant/Research Support Consulting Fees/Honoraria Abbott, Biotronik, Biosensors, Claret Medical, Direct Flow Symetis

3 2002 Cribier Tests performed by and data on file at Abbott Vascular. Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany

4 TAVI 24 French 14 French Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany

5 Transfemoral TAVI 2017 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany

6 TAVI: inoperable patients
Leon et al. NEJM 2010 Contilia Herz- und Gefäßzentrum, Elisabeth Krankenhaus Essen

7 TAVI: high-risk patients
Smith et al. NEJM 2011 Contilia Herz- und Gefäßzentrum, Elisabeth Krankenhaus Essen

8 TAVI: intermediate risk patients
Leon et al. NEJM 2016 Contilia Herz- und Gefäßzentrum, Elisabeth Krankenhaus Essen

9 ESC/EACTS 2012 Guidelines Indications for TAVI
Vahanian A. et al | Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)| Eur Heart J (2012) 33 (19): Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany

10 2015 TAVI in Europe Data Source: European population: EUROSTAT database TAVI 2014 and 2015 procedures: BIBA medical (Independent third party data) Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany

11 2015 TAVI in Europe EAPCI Initiative: TAVI for Life in France, Portugal and Poland Data Source: European population: EUROSTAT database TAVI 2014 and 2015 procedures: BIBA medical (Independent third party data) Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany

12 TAVI in Germany sAVR TAVI TA TAVI TF AQUA Report 2014
Tests performed by and data on file at Abbott Vascular. AQUA Report 2014 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany

13 TAVI in Germany: in-house mortality
Mortality risk (AKL Score) sAVR TAVI TA TAVI TF Tests performed by and data on file at Abbott Vascular. AQUA Report 2014 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany

14 TAVI evolution in Germany
Incidence of sAVR, TA-TAVI, and TF-TAVI 2012–2015 Gaede L et al. | Trends in aortic valve replacement in Germany in 2015: transcatheter versus isolated surgical aortic valve repairn | Clin Res Cardio – Published online 11 January 2017 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany

15 TAVI evolution in Germany
Mortality acording to AKL risk score Gaede L et al. | Trends in aortic valve replacement in Germany in 2015: transcatheter versus isolated surgical aortic valve repairn | Clin Res Cardio – Published online 11 January 2017 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany

16 Are we ready for expanding TAVI indications to moderate and low risk?
Summary I Are we ready for expanding TAVI indications to moderate and low risk? I believe we are! Randomized trial data are getting better from prohibitive to intermediate risk patients Real life data show that the current heart team process is able to select the right patients for TAVI even at a low risk for surgery However ... trials still needed to determine which patients may profit from surgery or should not undergo TAVI at all Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany

17 Summary II Some open questions when expanding the TAVI indication to moderate and low risk patients: What about patients with femoral access problems? What about patients with severe calcification on the native valve or in the LVOT? What about patints with reduced LV function? Is durability a problem when turning to younger age? What is the optimal medical management for TAVI? Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany

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