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Transcatheter Aortic Valve Replacement

Transcatheter Aortic Valve Replacement. A paradigm shift for cardiology A victory for patients. @ yuripridemd. Yuri B. Pride, MD, FACC, FSCAI Georgia Osteopathic Medical Association Fall CME Program October 26, 2019. Disclosures. No relevant disclosures Consulting, 2009-present

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Transcatheter Aortic Valve Replacement

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  1. Transcatheter Aortic Valve Replacement A paradigm shift for cardiology A victory for patients @yuripridemd Yuri B. Pride, MD, FACC, FSCAI Georgia Osteopathic Medical Association Fall CME Program October 26, 2019

  2. Disclosures • No relevant disclosures • Consulting, 2009-present • Boston Clinical Research Institute • Roche • Novo Nordisk • Astellas Pharmaceuticals • Amarin • Pfizer • Gilead • Microport • Significant investment, Orchestra BioMed • Maker of drug-eluting balloon and novel pacemaker technology

  3. Normal valve function • Designed to prevent the backflow of blood • Two anatomic types in the heart • Atrioventricular – mitral and tricuspid • Usually have two leaflets • Because pressure in downstream chamber changes dramatically during systole, require papillary muscles to tether them shut • Semilunar – aortic and tricuspid • Usually have three leaflets

  4. Normal valve function

  5. Aortic stenosis • Age-related calcification of the aortic valve leaflets • Accelerated in patients with a bicuspid aortic valve

  6. Bicuspid aortic valve

  7. Prevalence of aortic stenosis 16.5 Million People in US Over the Age of 652 • Estimated to be present in up to 7% of the US population over 65 years • More likely to affect men than women • 80% of patients with symptomatic aortic stenosis are male Percentage Diagnosed with Aortic Stenosis

  8. Physical exam • Murmur • Crescendo-decrescendo • Heard best at the base (RUSB) • Radiates to clavicle and/or carotid • Loss of S2 • Pulsus parvus et tardus • Signs of congestive heart failure

  9. Symptoms of aortic stenosis • Symptoms arise from and increase in LV wall stress, followed by an increase in LV size and decreased cardiac output • Angina • Dyspnea • Syncope

  10. Importance of symptoms

  11. Sobering perspective 5-Year Survival8 Survival, % Breast Cancer Lung Cancer Colorectal Cancer Prostate Cancer Ovarian Cancer Severe Inoperable AS* *Using constant hazard ratio. Data on file, Edwards Lifesciences LLC. Analysis courtesy of Murat Tuczu, MD, Cleveland Clinic

  12. Diagnosis • Echocardiography • Measure velocity of flow across LVOT • Measure size of LVOT • Measure velocity across aortic valve • Compute size of aortic valve

  13. Diagnosis • Cardiaccatheterization • Allows for direct measurement of gradient across the aortic valve

  14. Diagnosis

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