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![Contraindications and exclusion
criteria for TAVI are as follows:
Evidence of an acute MI at 1 month or less
before the intended treatment (defined as Q-wave
MI, or non–Q-wave MI with CK-MB twice normal in
the presence of MB elevation and/or troponin level
elevation [WHO definition].](https://image.slidesharecdn.com/tavi-161220092345/75/Tavi-Transcatheter-Aortic-Valve-Replacement-TAVI-TAVR-13-2048.jpg)
Uploaded byDr.Hasan Mahmud
Tavi,Transcatheter Aortic Valve Replacement, TAVI,TAVR,
Transcatheter aortic valve implantation (TAVI) has been developed as an alternative to surgical aortic valve replacement for high-risk patients. TAVI involves threading a collapsible valve through blood vessels and implanting it to replace the diseased valve. Over 30,000 high-risk patients with severe aortic stenosis have undergone TAVI, based on evidence from studies showing it is safer than surgery for this group. TAVI indications may expand as longer-term data on outcomes becomes available and the procedure requires a multidisciplinary team approach and dedicated training.
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Tavi,Transcatheter Aortic Valve Replacement, TAVI,TAVR,
- 1. Transcatheter aortic valve implantation(TAVI) DR.HASANMAHMUD NHFH&RI
- 2.
- 3. Severe symptomaticaortic stenosis carries a poor prognosis. Surgical aortic valve replacement has been the standard of care in adults with severe symptomatic AS. The risks associated with surgical aortic valve replacement are increased in: (High Risk Population) Elderly patients: + Following Co Morbidity Severe systolic heart failure CVD CAD PVD CKD Ch respiratory dysfunction.
- 4. Transcatheter aortic valve implantation(TAVI)has been developed as an alternative to the surgical approach in high-risk population.
- 5.
- 6. TAVI • More than30,000 patients with severe symptomatic aortic stenosis considered high risk for surgery have undergone the treatment. • This technique is still in its early stages, but rapidly growing evidence has been developed through observational studies, national and device-specific registries,and randomized clinical trials.
- 7. Indication: Currently, there areno established indications or guidelines for TAVR in the United States. Indications are based on following trial and consensus. PARTNER Trial - Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010 Oct 21. 363(17):1597-607. ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol. 2012 Mar 27. 59(13):1200-54.
- 8. Indication No 1: Patientswith calcific aortic valve stenosis with the following echocardiographic criteria: Mean gradient greater than 40 mm Hg or jet velocity more than 4 m/s and an initial aortic valve area (AVA) of less than 0.8 cm 2 or indexed effective orifice area (EOA) of less than 0.5 cm 2/m 2; Qualifying AVA baseline measurement must be within 45 days of the date of the procedure
- 9. Indication No 2: One cardiac interventionalist and 2 experienced cardiothoracic surgeons agree that medical factors either preclude operation or are high risk for surgical aortic valve replacement, based on a conclusion that the probability of death or serious irreversible morbidity exceeds the probability of meaningful improvement. The surgeons' consult notes shall specify the medical or anatomic factors leading to that conclusion and include a printout of the calculation of the Society of Thoracic Surgeons (STS) score to additionally identify the risks in the patient; at least 1 of the cardiac surgeon assessors must have physically evaluated the patient
- 10. Indication No 3: Patientis deemed to have symptomatic aortic valve stenosis, as differentiated from symptoms related to comorbid conditions and as demonstrated by New York Heart Association (NYHA) functional class II or greater.
- 11. In the EuropeanUnion, Transcatheter Aortic Valve Implantation is performed in patients with severe aortic stenosis who are high-risk surgical candidates with a logistic EuroScore of more than 20% and in patients who have a contraindication to surgical aortic valve replacement.
- 13. Contraindications and exclusion criteriafor TAVI are as follows: Evidence of an acute MI at 1 month or less before the intended treatment (defined as Q-wave MI, or non–Q-wave MI with CK-MB twice normal in the presence of MB elevation and/or troponin level elevation [WHO definition].
- 14. Contraindications…. Aortic valve isa congenital unicuspid or congenital bicuspid valve or is noncalcified. Mixed aortic valve disease ( AS+ AR) with predominant AR (>3+). Hemodynamic or respiratory instability requiring inotropic support, mechanical ventilation, or mechanical heart assistance within 30 days of screening evaluation.
- 15. Contraindications…. Need for emergencysurgery for any reason HOCM with or without obstruction. Severe left ventricular dysfunction with LVEF of less than 20%. Severe pulmonary hypertension RV dysfunction. Echocardiographic evidence of intracardiac mass, thrombus, or vegetation.
- 16. Contraindications… A known contraindicationor hypersensitivity to all anticoagulation regimens or an inability to undergo anticoagulation for the study procedure. Native aortic annulus smaller than 18 mm or larger than 25 mm as measured with echo. MRI-confirmed stroke or TIA within 6 months (180 days) of the procedure.
- 17. Contraindications… Estimated life expectancyof less than 12 months due to noncardiac comorbid conditions. Severe incapacitating dementia. Severe MR. Renal insufficiency (creatinine level >3 mg/dL) and/or end-stage renal disease requiring chronic dialysis at the time of screening.
- 18. Contraindications: Significant aorticdisease, including abdominal aortic or thoracic aortic aneurysm defined as a maximal luminal diameter of 5 cm or greater, marked tortuosity, atheroma or narrowing (especially with calcification and surface irregularities) of the abdominal or thoracic aorta. Severe "unfolding" and tortuosity of the thoracic aorta.
- 21. Aortic Regurgitation •ARis typically paravalvular mild or mild-moderate severity •Most AR disappears or reduces at 1 yr follow-up.
- 22.
- 23. (A) Left maincoronary artery occlusion resulting from a bulky leaflet displaced over the ostium. (B) Successful percutaneous intervention restored left coronary flow.
- 24. The principal transcatheteraortic valve implantation devices currently in use: (A) Edwards Sapien XT bioprosthesis and (B) Medtronic CoreValve® bioprosthesis
- 25. • Implanted since2002 • Transfemoral, transapical, alternate access routes • Bovine pericardium leaflets • Cobalt-chromium balloon expandable stent • Annular fixation • Sub coronary implant
- 26. Medtronic CoreValve Penroseprogram was the first CoreValve program in CO, NM, UT, WY Retrograde approach only Equine Pericardium Leaflets Nitinol Self-Expanding Annular and Supra-coronary fixation 18fr delivery system Offers a 31mm valve size
- 28.
- 29. Conclusion…. • Catheter basedtreatment of aortic stenosis is improving. • Restenosis after valvuloplasty has been overcome after development of TAVI. • Indications for TAVI can be expanded after the availability of follow up of patients of the cohort. • Team approach is essential for successful procedure. • Training required for performance of TAVI and dedicated imaging instruments. • Patient selection is complex.