1. TAVR Pearls Addressing the Shortcomings of the Current TAVR Generation
Title Slide Layout
Moderator
Ted E. Feldman, MD
Director
Cardiac Catheterization Laboratory Evanston Hospital
Evanston, Illinois

2. Professor of Cardiology and Medicine Monash University
Panelists
Ian T. Meredith, MBBS, PhD
Professor of Cardiology and Medicine
Monash University
Director, MonashHeart
Monash Medical Centre
Southern Health
Melbourne, Australia
Nicolo Piazza, MD, PhD
Assistant Professor and Co-Director Structural Heart Disease Program
McGill University Health Centre Interventional Cardiology
German Heart Center Munich
Munich, Germany
Michael J. Reardon, MD Professor of Cardiothoracic Surgery The Methodist DeBakey Heart Center
Houston, Texas
Title Slide Layout

3. TAVR Development Originally large delivery profiles: up to 25 French
High rate of vascular complications (15%-25%)
Mortality rates at 30 days (10%-15%) were then considered acceptable
Now complication rates much lower
Evolution of devices and careful patient selection

4. Importance of Imaging Originally used 2-dimensional imaging
3-dimensional imaging has become key in selecting valve size and placement
Retrospective analyses comparing valve size in patients based on echo vs estimation using CT, approximately 50% of patients received the incorrect size valvea
Number of paravalvular leaks was tremendously high
Limited number of valve sizes available  
Piazza N. JACC Cardiovasc Interv. In press.[2]

5. CTA Assessment of Aortic Valve Annulus
Image courtesy of Ted E. Feldman, MD.

6. The Ice Cream Cone Analogy
Content Slide Layout: TEXT .. ..
Images courtesy of Ian T. Meredith, MBBS, PhD.

7. CTA Prediction of TAVR Working Angle
Image courtesy of Ted E. Feldman, MD.

8. Repositioning and Retrievability
A variety of second-generation devices are repositionable and fully retrievable.
A one-to-one connection is needed between the handle outside the body and the movement of the valve in situ.

9. Evaluable Echocardiograms, %
REPRISE II
Aortic Regurgitation Over Time
Combined
Paravalvular
100
15.2% 80 60
Evaluable Echocardiograms, % 40
Content Slide Layout: graph 20
n = n = n = n = 103
Meredith IT. TCT 2013.[3] 9

10. Irregular annulus + concentric valve = paravalvular leak
Adaptive seal
Images courtesy of Ian T. Meredith, MBBS, PhD.

11. REPRISE II Conclusions
Successful valve implantation and positioning in all 120 patients
Primary device performance end point met
Low mortality (4.2%) and disabling stroke (1.7%) at 30 days
No embolization, ectopic valve deployment, or TAV-in-TAV
Negligible aortic regurgitation
Clinical event rates consistent with those reported for other valves
Meredith IT. TCT 2013.[3]

12. Abbreviations
2D = 2-dimensional 3D = 3-dimensional CT = computed tomography CTA = computed tomography angiogram LV = left ventricular TAVR = transcatheter aortic valve replacement

13. References
1. ClinicalTrials.gov. Safety and efficacy study of the Medtronic CoreValve® System in the treatment of severe, symptomatic aortic stenosis in intermediate risk subjects who need aortic valve replacement (SURTAVI). clinicaltrials.gov/show/NCT Accessed December 1, 2013.
2. Piazza N. Erroneous measurement of the aortic annular diameter using 2-dimensional echocardiography resulting in inappropriate CoreValve size selection: a retrospective comparison with multislice computed tomography. JACC Cardiovasc Interv. In press.
3. Meredith IT. REPRISE II: A prospective registry study of transcatheter aortic valve replacement with a repositionable transcatheter heart valve in patients with severe aortic stenosis. Presented at: Transcatheter Cardiovascular Therapeutics Meeting; October 27-November 1, 2013; San Francisco, CA.
4. Sponga S, Perron J, Dagenais F, et al. Impact of residual regurgitation after aortic valve replacement. Eur J Cardiothorac Surg. 2012;42: