trans catheter aortic valve implantation should we all be doing this l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Trans-catheter Aortic Valve Implantation Should we all be doing this? PowerPoint Presentation
Download Presentation
Trans-catheter Aortic Valve Implantation Should we all be doing this?

Loading in 2 Seconds...

play fullscreen
1 / 52

Trans-catheter Aortic Valve Implantation Should we all be doing this? - PowerPoint PPT Presentation


  • 370 Views
  • Uploaded on

Trans-catheter Aortic Valve Implantation Should we all be doing this?. Dr Philip MacCarthy BSc PhD FRCP Consultant Cardiologist King’s College Hospital, London, UK. BCIS Autumn Meeting, Crewe Hall, Crewe, September 26th 2008. Otto et al N Engl J Med 1999;341:142–7 . Is there an unmet need?.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Trans-catheter Aortic Valve Implantation Should we all be doing this?' - libitha


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
trans catheter aortic valve implantation should we all be doing this

Trans-catheter Aortic Valve ImplantationShould we all be doing this?

Dr Philip MacCarthy BSc PhD FRCP

Consultant Cardiologist

King’s College Hospital, London, UK.

BCIS Autumn Meeting, Crewe Hall, Crewe, September 26th 2008

trans catheter aortic valve implantation
Trans-catheter aortic valve implantation
  • CoreValve ‘Revalving’ system – trans-femoral
  • Edwards Sapien™ prosthesis
    • Trans-femoral (using the ‘RetroFlex’ catheter)
    • Trans-apical (using the ‘Ascendra’ catheter)
king s college hospital experience
King’s College Hospital Experience
  • 35 patients treated with the Edwards device
    • 17 Trans-femoral
    • 18 Trans-apical
  • First 17 of these as part of the PARTNER-EU study,
  • Next 18 in the SOURCE registry
slide23

King’s College Hospital Experience

  • 20 women (57%)
  • Mean age - 83.9yrs
  • Mean Log Euroscore - 20.3 (porcelain aorta)
  • Mean peak AV gradient - 85.8mmHg
  • Mean AVA - 0.61cm2
  • Median LOS - 8 days
  • In-hospital mortality - 2 (5.7%)
patient work up
Patient work-up
  • Lung/renal function tests
  • Carotid Dopplers
  • CT aorta – without contrast
  • Trans-thoracic echo
    • Morphology of AV – peak/mean grad + AVA
    • Dimensions of AV annulus
    • Morphology of septum
    • Presence/mechanism of MR
    • LV systolic function
    • PAP if possible
  • TOE – if annulus 24mm or greater
patient work up25
Patient work-up
  • Cardiac Catheterisation
    • Coronary angiogram
    • RH cath with PAP
    • Aortogram (PA or LAO) – 30ml @ 15ml/sec
    • Iliofemoral angiogram – 30ml @ 6ml/sec
    • No angioseal!
the team
The Team
  • Dedicated Anaesthetist(s)
  • Echocardiologist
  • Perfusionist
  • Surgical scrub nurse
  • Cath lab scrub nurse
  • Surgeon(s)
  • Interventional Cardiologist(s)
  • The Company (for valve crimping)
slide27

CP bypass

Surgicalkit

Screens

Echo Machine

Nurse

CT Surg

Echo

Fluoro

Rad

Nurse

Cardio

Tech

Anaes. Machine

Anaes

Cath lab kit

ODA

Valve crimping

Rep

potential peri procedural complications
Potential peri-procedural complications
  • Vascular access
    • Passage of introducer sheath
    • Surgical repair
    • Iliac dissection/rupture
  • Balloon valvuloplasty
    • Aortic regurgitation
    • CHB on background of RBBB
  • Valve deployment
    • Occlusion of coronary ostia
    • Displacement of prosthesis
  • Rapid pacing
  • Other –
    • Interference with the mitral valve
    • CVA
the importance of case selection
The importance of case selection
  • Patients with advanced pulmonary disease may do better with a TF approach
  • Poor LV systolic function - less room for error
  • The aetiology of depressed LV function and MR
  • Beware RBBB
some words of caution
Some words of caution
  • The precise need is unknown
  • There is currently no long-term data
  • Funding issues remain a problem
so should we all be doing it51
So should we all be doing it?

At the moment NO - because:

  • Experience should be concentrated in major centres
  • New centres should be closely proctored
  • Centre must have:-
    • Experienced cardiac anaesthetists
    • Cardiopulmonary bypass facility
    • Excellent imaging ability
    • Dedicated cardiac ITU/recovery area
  • Long-term data/a solution to funding is needed
acknowledgements
Acknowledgements
  • King’s TAVI Team:-
    • CT Surgeons - Olaf Wendler & Ahmed El-Gamel
    • Cardiologists – Phil MacCarthy & Martyn Thomas
    • Echocardiologist – Mark Monaghan
    • Anaesthetists – Emma Alcock & Kailasam Rajagopal
    • Research Sister/Co-ordinator – Karen Wilson/Beth Brickham
    • Other cath lab/theatre staff involved