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TAVR Requirements for the Cath Lab

Published byWalter Williamson Modified over 6 years ago

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Presentation on theme: "TAVR Requirements for the Cath Lab"— Presentation transcript:

1 TAVR 2016- Requirements for the Cath Lab
TAVR Management Research Vs Commercial Petros Okubagzi, MD MCRN Washington, DC

2 Petros Okubagzi, MD  I have no relevant financial relationships

3 TAVI Implants per Annum
. The annual number of implants increased 33-fold from 455 in 2007 to 14,946 in 2011 Registry data

4 TAVI Centres 2007: 37 Registry data

5 Always enroll in research if possible!!

6 Vinod H. Thourani, MD on behalf of The PARTNER Trial Investigators
SAPIEN 3 Transcatheter Aortic Valve Replacement Compared with Surgery in Intermediate-Risk Patients: A Propensity Score Analysis Was a study a few months back Vinod H. Thourani, MD on behalf of The PARTNER Trial Investigators ACC 2016 | Chicago | April 3, 2016

7 Screening Process Review of History Echocardiogram
CT- Heart Structure and Iliofemoral Frailty Assessment Surgeon Review Patient review

8 Clinical History Ht = 175 cm, Wt = 84 kg, BMI = 27.4, BSA = 2.0 m2
STS score: 4.31% Relevant history: XX y/o male with severe AS and progressive dyspnea. Ht = 175 cm, Wt = 84 kg, BMI = 27.4, BSA = 2.0 m2 PMHx: Hypertension Hyperlipidemia Spinal stensois s/p surgical repair Criteria Score Cutoff Activities of Daily Living 6 ≤ 4/6 Grip Strength 34 < 30 kg 15-Foot Walk 8.0 > 6 sec Albumin 3.4 < 3.5g/dl TOTAL 2

9 Echocardiogram Research requires EF>20 AVA<1 MG>40 m/sec 3.45
Echo Variable (TTE) Measure Trileaflet valve Yes Peak Velocity 3.45 m/sec Mean Gradient 28 mmHg Calculated AVA 0.95 cm2 Calculated AVA index 0.48 cm2/m2 Severity of AR None Severity of MR Ejection Fraction 60 % TTE/TEE annulus diameter RV Pressures NA Comment Research requires EF>20 AVA<1 MG>40

10 CT Analysis (2/14/2017) Aortic Root by CT Measure
Sinus of Valsalva Diameter 36.9(L)x35.1(R)x36.7(N)mm Sinotubular Junction Diameter 30.4 x 32.6 mm Sinus Height 21.9(L)x24.6(R)x26.1(N)mm Left Coronary Height 11.6 mm Right Coronary Height 21.3 mm Aorta 32.8 x 33.8 mm Angle 60.0°

11 Access (2/14/2017) Research requires larger vessel sizes Right Left
CIA 8.0 mm 9.1 mm EIA 7.1 mm 7.0 mm CFA 7.2 mm 8.1 mm Research requires larger vessel sizes

12 Heart team

13 Access

14 Transcaval Access

15 Commercially available valves

16 Second Generation@ MWHC
Lotus Valve- Boston Scientific Portico valve- St. Jude/ Abbott Jena valve

17 Transfemoral Commercial Edwards Sapien S3 Medtronic Evolut Research
Portico Jena Valve Lotus

18 Transapical Commercial Edwards Sapien S3 Medtronic Evolut Research
Portico Jena Valve Lotus

19 Transaortic Access Commercial Edwards Sapien S3 Medtronic Evolut
Research Portico Jena Valve Lotus

20 Subclavian Access Commercial Edwards Sapien S3 Medtronic Evolut
Research Portico Jena Valve Lotus

21 Transcaval Access Commercial Edwards Sapien S3 Medtronic Evolut
Research Portico Jena Valve Lotus

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