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TAVI Trans-chateter Aortic Valve Implantation

TAVI Trans-chateter Aortic Valve Implantation. Hrvoje Stipić i Zvonimir Korda. Aortic stenosis. Aortic stenosis haemodynamic. Aortic Stenosis is Life-thretening and Progress Rapidly. Treatment Options and Timing Matter. Mortality of Nonsurgically Treated Patients with Severe AS.

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TAVI Trans-chateter Aortic Valve Implantation

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  1. TAVITrans-chateter Aortic Valve Implantation Hrvoje Stipić i Zvonimir Korda

  2. Aortic stenosis

  3. Aortic stenosis haemodynamic

  4. Aortic Stenosis is Life-thretening and Progress Rapidly Treatment Options and Timing Matter

  5. Mortality of Nonsurgically Treated Patients with Severe AS

  6. AVR has become more common in the elderly

  7. Croatia is getting older… Lifetime expectancy at birth men women men women 2020 2050

  8. …and this will continue... Proportions of young, working and old population in Croatia men women men women 2020 2050

  9. Potential AS population • Croatia: 4,5 million • 20.000 with AS (0.5%) • 3200 severe AS (16%) • 1600 symptomatic (50%) • 480 do not undergo AVR (30%)

  10. What do we currently have to offer?

  11. What did we have to offer?

  12. What do we currently have to offer?

  13. Patient selection or nonselection

  14. Risc Scores

  15. High Risc AVR Patients with Poor Outcomes

  16. What Do We Currently Have to Offer for High-Risc Patients?

  17. TAVITrans-chateter Aortic Valve Implantation

  18. Dr. Alain CribierFirst in Man Pioneer

  19. Dr. Alain CribierFirst in Man Pioneer

  20. First in Croatia 2011 y.

  21. Evolution of Aortic Valve Implant

  22. TAVI Devices

  23. Core Valve

  24. Core Valve

  25. Core Valve

  26. Core Valve

  27. TAVI

  28. TAVI

  29. Core Valve Case Example

  30. TAVI- Numbers of Countries and Centers

  31. Potential population • Croatia: 4,5 million • 20.000 with AS (0.5%) • 3200 severe AS (16%) • 1600 symptomatic (50%) • 480 do not undergo AVR (30%) •  200 TAVI candidates (50%)

  32. TAVI

  33. My prediction: Repetition of and Old Story

  34. Percutaneous Aortic Valve Prosthesis

  35. TAVI

  36. Con:

  37. Pro:

  38. TAVI : ozračje 2010 g. BDP

  39. TAVI : činjenice TAVI VALVULA KIR. VALVULA TAVI VALVULA JE 20 PUTA SKUPLJA OD KIRURŠKE VALVULE

  40. TAVI činjenice 2 • TAVI skuplji nego kirurgija • Cijena zahvata isplaćena od osiguravatelja je ista • TAVI mora biti jednako dobar ili bolji od kirurške zamjene aortalnog zalistka

  41. AVR: 2010 vs 2011 2010 2011 No. 104 90 Dob 66.08 65.03 Žene 41 (39.4%) 31 (34%) Muški 63 59 EuroScore log. 6.69 6.71 EF (%) 58.7% 53.8% ICU (stay/h) 67.22 72.4 LOS (d) 9.21 12.45 Smrtnost (30d) 1 (0,9%) 1 (1,1%)

  42. AVR: 2010 vs 2011

  43. TAVI i KIRURGIJA • zajednički program kardiologije i kirurgije • rješavanje najrizičnijih bolesnika • ograničeni financijski resursi • početak 2010 • sustavno provođenje od 2010 do 2012 godine

  44. AVR TAVI • Izuzetno visok rizik za kirurgiju • Porculanska aorta • Child Pough B ili C • Dob + CABG+AS • Dob+ izbor bolesnika

  45. KARDIOLOGIJA AVR KANDIDAT TAVI KANDIDAT KARDIOKIRURŠKI SASTANAK Lista čekanja AVR TAVI Odbijeni

  46. 161 pt. AVR kand. 76% TAVI kand. 24% KARDIOKIRURŠKI SASTANAK 161 pt. AVR 56%(90) Lista čekanja AVR 24%(39) TAVI 1.2% (2) TAVI 10%(17) Odbijeni 2.4% (4) Odbili op. 5.5% (9)

  47. TAVI vs ex TAVI kandidat TAVI ex.TAVI kan. No. 17 15 Dob (g.) 81.1 81 Žene 8 6 Muški9 9 EF (%) 53.3 51 p (sr) 56.3 58.6 EuroScore log. 19.64 17.70

  48. TAVI vs ex TAVI kandidat TAVIex. TAVI kan. AVR 17 9 AVR+CABG 0 6 Reoperacija 0 2 ICU (h) 131,57 143,53 LOS (d) 10.4 10.25 Krvarenje 1 1 AI ≥ 2 6 1 Smrtnost (30d) 0 0 Smrtnost (uk.) 2 0

  49. TAVI - INDIKACIJE INDIKACIJA n (17)dob (g.) Porculanska aorta 5 78,83,85,84,78 CABG 4 74,78,84,76 CABG+resutura 1 78 Skolioza 1 81 Child Pough B, C 0 (2) 0 Dob + izbor bol. 6 76,86,83,89,81,85

  50. TAVI: realnost • Indikacija : kirurški inoperabilni bolesnik (izuzetno visok rizik) • Visoka dob ne znači inoperabilitet. • Ne postoji relevantna studija koja prati TAVI valvule duže od 5 godina.

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