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TAVR-Transcatheter Treatment of Aortic Stenosis Comes of Age PowerPoint Presentation

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Description : Check out this medical titled "TAVR: Transcatheter Treatment of Aortic Stenosis Comes of Age” by Muhammad Raza, MD, FACC, FSCAI, RPVI.

This medical is about transcatheter treatment of aortic stenosis (AS), a minimally invasive alternative to surgical aortic valve replacement (SAVR) for patients with symptomatic severe AS who are at intermediate or high surgical risk. Transcatheter aortic valve replacement (TAVR) involves the placement of a new aortic valve via a catheter, which is inserted through a small incision in the groin or chest and threaded up to the heart.

During the TAVR procedure, a collapsible artificial valve is inserted through a catheter and guided to the site of the diseased aortic valve. The new valve is then deployed inside the existing valve, pushing aside the old valve and taking over its function. The entire procedure is performed under local anesthesia and conscious sedation, with a shorter recovery time and reduced risk of complications compared to SAVR.

TAVR has been shown to improve symptoms, quality of life, and survival in patients with severe AS who are not candidates for surgery or who are at high surgical risk. The procedure is now routinely performed in many centers around the world, and newer generations of TAVR devices are being developed to improve outcomes and expand the eligibility criteria for this treatment.

However, TAVR is not suitable for all patients with severe AS, and careful patient selection is important to achieve optimal outcomes. Patients who are at low surgical risk are generally still recommended to undergo SAVR, which remains the gold standard for the treatment of severe AS.

Tags : TAVR, Transcatheter Treatment of Aortic Stenosis, minimally invasive alternative to surgical aortic valve replacement, SAVR, Cardiology, Cardiology

Published on : Jun 01, 2023 | Views : 832 | Downloads : 4

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Slide 1-

“TAVR: Transcatheter Treatment of Aortic Stenosis Comes of Age” Muhammad Raza, MD, FACC, FSCAI, RPVI. Interventional cardiologist Director, Cardiac Cath Lab, Crozer Chester Medical Center, Upland, PA
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Disclosure Consultant and Proctor – Medtronic Consultant – Abbott Vascular
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Natural History of Aortic Stenosis Age (years) Survival (percent) Increasing obstruction, myocardial overload Average Age Death Latent Period Symptoms 40 50 60 70 80 from Ross and Braunwald, Circulation 1968;38:V-61 100 80 60 40 20 0
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Therapeutic Options in AS Medical therapy! AS = Mechanical problem = Mechanical solution No medical therapy effective in delaying progression or altering outcome of AS Surgical therapy Transcatheter therapy
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TAVR System’s supra-annular valve function achieves larger EOAs and lower gradients than intra-annular TAV designs, lessening the risk of patient-prosthesis mismatch especially in smaller annulus patients. 1 6 Hemodynamics Performance Abdelghani, et al. JACC, 2018. Intra-Annular TAV Design Evolut R Supra-Annular TAV
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PARTNER 1 Trial – 5-Year Outcome All-Cause Mortality No. at Risk HR [95% CI] =0.91 [0.72, 1.14] p (log rank) = 0.41 63.3% 63.3% Error Bars Represent 95% Confidence Limits
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1077 1043 1017 991 963 944 859 836 808 795 Number at risk: SAPIEN 3 TAVR Surgery PARTNER 11 Trial All-cause mortality* 8 *The PARTNER II trial intermediate-risk cohort unadjusted clinical event rates.
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PARTNER 11 Trial Disabling Stroke* 9 1077 1033 1008 884 953 806 778 764 *The PARTNER II trial intermediate-risk cohort unadjusted clinical event rates. SAPIEN 3 TAVR 944 825 Number at risk: Surgery
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All-cause mortality PARTNER 111 Trial
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Disabling Stroke PARTNER 111 Trial
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TAVR is standard of care for majority of AS patients The fact that two separate groups using two separate valves have come to very similar conclusions, this not only doubles the acceptability, but it quadruples it." Eugene Braunwald, MD
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Severity of PPMdefinition in the aortic Valve Position 13 Severe Moderate Mild Indexed EOA (cm2/m2) 0.65 0.85 EOAi in obese (cm2/m2) 0.6 0.7 Kappetein, A. Pieter, et al. European heart journal 33.19 (2012): 2403-2418. Transcatheter Valve Hemodynamics | May 2018 Patient Prosthesis Mismatch
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Patient Prosthesis Mismatch
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Structural Valve Degeneration
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Structural Valve Degeneration
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Coronary Access Post TAVR
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Natural History of Aortic Stenosis Age (years) Survival (percent) Increasing obstruction, myocardial overload Average Age Death Latent Period Symptoms 40 50 60 70 80 from Ross and Braunwald, Circulation 1968;38:V-61 100 80 60 40 20 0
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Earlier Intervention Active Trials There is interest in using TAVR to intervene earlier in the AS disease process to prevent inevitable myocardial damage and functional decline
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Summary TAVR is standard of care for patients with AS Short Term Outcomes: Mortality Stroke Paravalvular Leak Access Permanent PaceMaker Long-term Outcomes: Patient Prothesis Mismatch Durability Coronary Access TAVR in TAVR Technology is going to continue to improve
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TAVR at CCMC
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Thank you