Presentation is loading. Please wait.

Presentation is loading. Please wait.

David R. Holmes, MD, Michael J

Similar presentations


Presentation on theme: "David R. Holmes, MD, Michael J"— Presentation transcript:

1 2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement 
David R. Holmes, MD, Michael J. Mack, MD, Sanjay Kaul, MBBS, Arvind Agnihotri, MD, Karen P. Alexander, MD, Steven R. Bailey, MD, John H. Calhoon, MD, Blase A. Carabello, MD, Milind Y. Desai, MBBS, Fred H. Edwards, MD, Gary S. Francis, MD, Timothy J. Gardner, MD, A. Pieter Kappetein, MD, PhD, Jane A. Linderbaum, MS, CNP, Chirojit Mukherjee, MD, Debabrata Mukherjee, MD, Catherine M. Otto, MD, Carlos E. Ruiz, MD, PhD, Ralph L. Sacco, MD, Donnette Smith, James D. Thomas, MD  The Annals of Thoracic Surgery  Volume 93, Issue 4, Pages (April 2012) DOI: /j.athoracsur Copyright © 2012 The Society of Thoracic Surgeons, the American College of Cardiology Foundation, the American Association for Thoracic Surgery, and the Society for Cardiovascular Angiography and Interventions Terms and Conditions

2 Fig 1 Sapien Valve. Source: Edwards Lifesciences.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons, the American College of Cardiology Foundation, the American Association for Thoracic Surgery, and the Society for Cardiovascular Angiography and Interventions Terms and Conditions

3 Fig 2 CoreValve. The Medtronic CoreValve System is currently limited to investigational use in the United States. Source: Medtronic, Inc. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons, the American College of Cardiology Foundation, the American Association for Thoracic Surgery, and the Society for Cardiovascular Angiography and Interventions Terms and Conditions

4 Fig 3 PARTNER Trial Design.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons, the American College of Cardiology Foundation, the American Association for Thoracic Surgery, and the Society for Cardiovascular Angiography and Interventions Terms and Conditions

5 Fig 4 Benefit/Risk Balance in the PARTNER Trial. Data are shown for every 1,000 patients treated with TAVR instead of standard treatment in Cohort B (above) or standard AVR in Cohort A (below). The excesses listed are not mutually exclusive, because some patients had more than 1 event. Only data with statistically significant differences at 1 year of follow-up are shown except for deaths* (p=0.44) and atrial fibrillation† (p=0.07) in Cohort A. AR indicates aortic valvular regurgitation; AVR, surgical aortic valve replacement; and TAVR, transcatheter aortic valve replacement. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons, the American College of Cardiology Foundation, the American Association for Thoracic Surgery, and the Society for Cardiovascular Angiography and Interventions Terms and Conditions

6 Fig 5 Reconstructed Multidetector Computed Tomographic Images of the Abdominal Aorta and Its Pelvic Branches Demonstrating Tortuosity and Extensive Calcific Atherosclerosis. The extent and degree of peripheral arterial disease is essential in determining the feasibility and safety of transfemoral approaches. In some patients with extensive disease, alternative approaches such as direct aortic, subclavian, or transapical procedures should be considered. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons, the American College of Cardiology Foundation, the American Association for Thoracic Surgery, and the Society for Cardiovascular Angiography and Interventions Terms and Conditions

7 Fig 6 Midesophageal Long-Axis TEE View Showing the Proper Positioning of a Sapien Valve (black line*) Across the Aortic Annulus Prior to Balloon Deployment. Note that approximately half the valve is above and below the annulus. Note also the difficulty of imaging due to shadowing from the prosthesis and annular and mitral valve calcification, as well as a prominent reverberation artifact, emphasizing the need for thorough training prior to providing procedural guidance. LA indicates left atrium. *Visible as black line. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons, the American College of Cardiology Foundation, the American Association for Thoracic Surgery, and the Society for Cardiovascular Angiography and Interventions Terms and Conditions

8 Fig 7 Mixed AR. Central and paravalvular AR following TAVR deployment in a biplane long- and short-axis TEE view. A1 and A2 are trivial paravalvular leaks, whereas B is a trivial central regurgitation, all of which are negligible. C is a more severe paravalvular leak, which was ameliorated by a second valve inflation. Ao indicates aorta; AR, aortic regurgitation; LA, left atrium; and LV, left ventricle. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons, the American College of Cardiology Foundation, the American Association for Thoracic Surgery, and the Society for Cardiovascular Angiography and Interventions Terms and Conditions

9 Fig 8 Severe AR. Long-axis TEE view showing severe AR following TAVR deployment (Panel A), confirmed by flow reversal in the descending aorta (Panel B). Short axis imaging (Panels C and D) demonstrates that this is due to failure of the leaflet in the left coronary position (arrow) to close in diastole, ultimately treated by deploying a second valve inside this one. Ao indicates aorta; AR, aortic regurgitation; LA, left atrium; and LV, left ventricle. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2012 The Society of Thoracic Surgeons, the American College of Cardiology Foundation, the American Association for Thoracic Surgery, and the Society for Cardiovascular Angiography and Interventions Terms and Conditions


Download ppt "David R. Holmes, MD, Michael J"

Similar presentations


Ads by Google