ECHO 2013 / Transcatheter Aortic and Mitral Valve Replacement The Future is Now 2
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Transcatheter Treatment of Aortic and Mitral Valve Disease: The Future is Now
Susheel Kodali, MD
Co-Director, Heart Valve Center
Director, Interventional Cardiology Fellowship Program
Columbia University Medical Center
Disclosure Statement of Financial Interest
Within the past 12 months, I or my spouse/partner have had a financial Interest /arrangement or affiliation with the organization (s) listed below
Affiliation/Financial Relationship |
Company |
Consulting Fees: |
Edwards Lifesciences |
Advisory Board: |
St. Jude Medical, Thubrikar Aortic Valve, Inc. |
Aortic Stenosis
Pathology
Normal
Degenerative |
Bicuspid |
Rheumatic |
Calcified |
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|
Natural History of Aortic Stenosis
100
100
8080
(percent) 6060
Survival 4040
2020
0 0
Latent Period
Increasing obstruction, |
Symptoms |
myocardial overload
Average Age Death
40 |
50 |
60 |
70 |
80 |
40 |
50 |
60 |
70 |
80 |
Age (years)
from Ross and Braunwald, Circulation 1968;38:V-61
Natural History of Aortic Stenosis
100
100
8080
(percent) 6060
Survival 4040
2020
0 0
Latent Period
Increasing obstruction, |
Symptoms |
myocardial overload
Average Age Death
40 |
50 |
60 |
70 |
80 |
40 |
50 |
60 |
70 |
80 |
Age (years)
from Ross and Braunwald, Circulation 1968;38:V-61
At Least 30% of Patients with Severe
Symptomatic AS are “Untreated”!
Severe Symptomatic Aortic Stenosis |
AVR |
Percent of Cardiology Patients Treated |
No AVR |
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100% |
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90% |
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30 |
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80% |
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41 |
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32 |
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31 |
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45 |
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48 |
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70% |
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60 |
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60% |
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50% |
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40% |
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68 |
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70 |
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69 |
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30% |
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59 |
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52 |
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55 |
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20% |
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40 |
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10% |
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0% |
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Bouma 1999 Iung* |
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Pellikka |
Charlson |
Bach |
Spokane |
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Vannan |
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2004 |
2005 |
2006 |
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2009 |
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(prelim) |
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(Pub. |
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Pending) |
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Under-treatment especially prevalent among patients managed by Primary Care physicians
1.Bouma B J et al. To operate or not on elderly patients with aortic stenosis: the decision and its consequences. Heart 1999;82:143-148
2.Iung B et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. European Heart Journal 2003;24:1231-1243 (*includes both Aortic Stenosis and Mitral Regurgitation patients)
3.Pellikka, Sarano et al. Outcome of 622 Adults with Asymptomatic, Hemodynamically Significant Aortic Stenosis During Prolonged Follow-Up. Circulation 2005
4.Charlson E et al. Decision-making and outcomes in severe symptomatic aortic stenosis. J Heart Valve Dis2006;15:312-321
Edwards Lifesciences
SAPIEN THV
Bovine Tissue |
|
ThermaFix Treatment |
|
Pericardial Mapping |
|
Leaflet Deflection |
|
Proprietary Processing |
|
] |
Skirt Height |
|
|
Edwards-SAPIEN THV |
|
RetroFlex 3 Delivery System
Distal End
•Unidirectional tip-deflecting flex catheter facilitates negotiating the arch
•Balloon catheter tapered distal end for crossing calcified native valve
Nose cone – 4.5 cm
Flex Catheter
RetroFlex 3 Procedure Animation
Intra-Procedural TEE:
Valve Positioning
Annulus
50% of the valve inferior to the plane of the annulus and 50% above
* Courtesy R. Hahn