TAVI between dreams and reality
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Transcatheter aortic valve implantation
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TAVI between dreams and reality
- 2. Aortic valve replacement Refused for Surgery Euro Heart Survey on Valvular Heart Disease (5001 Patients) 32 % did not undergo surgery ! Iung B. and al, Eur. Heart Journal 2003 : 24, 1231-1243 But cardiologists never lose the hope Interventional Cardiology „Credo‟ “Anything a cardiac surgeon can do, an interventional cardiologist can do as well or better percutaneously” AH Gershlick, 2003
- 3. First human implantation: Alain Cribier April 16, 2002 ( France) Bovine pericardium valve 23mm in diameter
- 8. • Vascular access – Sites • Transfemoral • Transapical – – – – Left ant. thoracotomy More direct, shorter catheter Septal hypertrophy Ascendra2, Sapien valve • Transaortic – – – – – Upper partial sternotomy Mini-sternotomy 2/3 RICS Aorta 5 cm above valve Less painful, familiar approach Manipulation of ascending aorta • Subclavian Percutaneous or Cut-down technique
- 11. “Feasibility trial” reports deployment of new device for TAVI in aortic insufficiency 23 May 2013, Paris, France: A new investigational device - the Helio System (TF-FA) - being developed for use with the Sapien XT Transcatheter Heart Valve was successfully deployed in all four patients in a small, first-in-human feasibility study of its use in high-risk aortic insufficiency reported at EuroPCR 2013. there were no in-hospital deaths. One patient had a stroke/TIA and one suffered minor vascular complication. One patient, who had preexisting renal impairment, had an acute kidney injury. The primary endpoint of freedom from all-cause mortality at 30 days was 100% all four patients were alive at one year. Aortic insufficiency improved from moderate to severe before the procedure to trivial at 30 days. Two patients followed up at 12 months had no aortic insufficiency at this time point.