transcatheter valve replacement: current state in 2017€¦ · 2.2% 1.7% no any stroke 3.4% 5.6% no...
TRANSCRIPT
![Page 1: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/1.jpg)
Transcatheter Valve Replacement:
Current State in 2017
Marc A. Sintek MD
Assistant Professor of Medicine
Interventional Cardiology
Cardiovascular Division
Washington University in St. Louis
Missouri ACP 2017 CME Meeting
Updates in Internal Medicine
September 17, 2017
Disclosures: Consultant Volcano Corporation
![Page 2: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/2.jpg)
Overview
• A Standard TAVR Case
• Evidence review and update for TAVR
• Evaluating Patients for TAVR
• Future of TAVR and unique TAVR populations
• Mitral valve therapies
• Complex TAVR Case
![Page 3: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/3.jpg)
Case XX
![Page 4: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/4.jpg)
• The original data (PARTNERS)
• Intermediate Risk Patients
• Durability and Safety updates
The Evidence for TAVR
CoreValve Evolute RSapien S3
![Page 5: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/5.jpg)
Brief history of TAVR
Alain Cribier:
First human transcatheter valve replacement (2002)
Slide Courtesy Edwards Life Sciences
![Page 6: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/6.jpg)
Brief history of TAVR
Slide Courtesy Edwards Life Sciences
![Page 7: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/7.jpg)
Brief history of TAVR
PARTNERS Cohort B PARTNERS Cohort A
(Inoperable) (High Risk)
NEJM 2010; 363:1597-1607. NEJM 2011;364:2187-98
![Page 8: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/8.jpg)
Brief history of TAVR
CoreValve Pivotal Trial
(High Surgical Risk)
CoreValve Extreme Risk Trial
(Inoperable)
JACC 2014; 63: 1972-81. NEJM 2014;370:1790-8.
![Page 9: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/9.jpg)
Low mortality and stroke ratesPatient selection, procedural techniques, device evolution
Edwards eSheathintroducer set
Improved vascular accessLower profile devices expands treatment possibilities
Increased treatment range Larger and smaller valves
RetroFlex 3 introducer sheath
22F 16F
NovaFlex+delivery system
RetroFlex 3delivery system
SAPIEN valve23 mm and 26 mm
SAPIEN XT valve23 mm, 26 mm, 29 mm
SAPIEN 3 valve20 mm, 23 mm, 26 mm, 29 mm
Edwards Commander delivery system
Edwards eSheathintroducer set*
14F
*Only used with 20 mm,23 mm,26 mm valve sizes
Brief history of TAVR
Slide Courtesy Edwards Life Sciences
![Page 10: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/10.jpg)
Brief history of TAVR
Slide Courtesy Edwards Life Sciences
![Page 11: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/11.jpg)
• 2032 patients with STS score between 4-8%.
• PCI/CABG allowed
• Sapein XT valve
PARTNER II
NEJM 2016; 374: 1609-20.
![Page 12: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/12.jpg)
PARTNER II
NEJM 2016; 374: 1609-20.
236 patients (11%) were transthoracic TAVR.
![Page 13: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/13.jpg)
PARTNER II
LEAK is BAD
NEJM 2016; 374: 1609-20.
![Page 14: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/14.jpg)
The PARTNER IIA and S3i TrialStudy Design
ASSESSMENT:
Optimal Valve
Delivery Access
ASSESSMENT:
Transfemoral
Access
PII S3in = 1078
Intermediate-Risk Symptomatic Severe Aortic Stenosis
VS. VS.
Intermediate-Risk Assessment by Heart Team
1:1 Randomization
Transfemoral (TF)Transapical /
Transaortic (TA / TAo)
1:1 Randomization
Transapical /
Transaortic (TA / TAo)Transfemoral (TF)
TF TAVR
SAPIEN 3
TA / TAo TAVR
SAPIEN 3Surgical
AVR
Surgical
AVRTF TAVR
SAPIEN XT
TA /TAo TAVR
SAPIEN XT
NoYes
PIIAn = 2032
![Page 15: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/15.jpg)
1077 1043 1017 991 963
944 859 836 808 795
Number at Risk:
SAPIEN 3 TAVR
Surgery
Months from Procedure
All-
Ca
use
Mo
rta
lity (
%)
0
10
20
30
40
7.4%
13.0%
1.1%
4.0%
0 3 6 9 12
TAVR with SAPIEN 3 Valve
Surgery (PIIA)
*The PARTNER II trial intermediate-risk cohort unadjusted clinical event rates.
1.1%
4.0%
PARTNER II S3i
Slide Courtesy Edwards Life Sciences
![Page 16: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/16.jpg)
0%
20%
40%
60%
80%
100%
PARTNER II S3iTrial SAPIEN 3
Valve
PARTNER IIA TrialSurgery
PARTNER II S3iTrial SAPIEN 3
Valve
PARTNER IIA TrialSurgery
Severe
Moderate
Mild
None / Trace
3.8%
1.5% 0.3%0.5%
Number of Echos:
SAPIEN 3 TAVR
Surgery
992 875
755 610
30 Days 1 Year
PARTNER II S3i Leak
Slide Courtesy Edwards Life Sciences
![Page 17: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/17.jpg)
• 1746 patients
• STS score 3-15% but heart
team agreed intermediate risk
(mean STS score was 4%).
• Corevavle 84% (Evolute R
16%).
SURTAVI
NEJM 2017; 376: 1321-31.
![Page 18: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/18.jpg)
SURTAVI
TAVR SAVR Significant
All cause
death
2.2% 1.7% No
Any Stroke 3.4% 5.6% No
Pacemaker 25.9% 6.6% Yes
Vascular
Complication
6.0% 1.1% Yes
SURTAVI 30 day Outcomes
NEJM 2017; 376: 1321-31.
![Page 19: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/19.jpg)
PARTNER I- 5 year
JACC Imaging 2017. 10: 15-25.
![Page 20: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/20.jpg)
TVT Registry
42,998 implants from 2011-2015
62% had STS <8% (intermediate) JACC 2017. 70: 29-41.
![Page 21: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/21.jpg)
TVT Registry
JACC 2017. 70: 29-41.
![Page 22: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/22.jpg)
TVT Registry
JACC 2017. 70: 29-41.
![Page 23: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/23.jpg)
• Understanding risk and STS score
• TAVR diagnostic testing
• “Cohort C”
• The heart team
The TAVR Evaluation
![Page 24: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/24.jpg)
The TAVR Evaluation
1. Does the patient have Severe AS?
2. Is the patient having symptoms of severe
aortic stenosis?
3. What is the best treatment?
![Page 25: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/25.jpg)
The TAVR Evaluation
http://riskcalc.sts.org
![Page 26: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/26.jpg)
The TAVR Evaluation
RISK LEVEL STS Risk of
Mortality
Low <3%
Intermediate 4-8%*
High >8%
Extreme >15%
![Page 27: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/27.jpg)
The TAVR Evaluation
• Consultation with 1 cardiologist and 2 cardiac
surgeons
• Echocardiogram
• Coronary angiogram
• Pulmonary function testing
• Carotid Dopplers
• TAVR protocol CT (gated CT with 1mm slices of
the heart, chest, abdomen and pelvis)
• Fraility Evaluation
![Page 28: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/28.jpg)
The CT is King
![Page 29: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/29.jpg)
“Cohort C”
JACC Invent 2014. 7:707-16.
![Page 30: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/30.jpg)
“Cohort C”
JACC Invent 2014. 7:707-16.
![Page 31: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/31.jpg)
The Heart Team Concept
RISK ANATOMY
![Page 32: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/32.jpg)
• Valve in Valve
• Pulmonic valve
The Unique “TAVR”
![Page 33: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/33.jpg)
Valve in Valve
Common Surgical Valves
Valve Failure
JACC 2011. 4:721-32.
![Page 34: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/34.jpg)
Valve in Valve
Global ViV registry
202 patients
93% Success rate
Circulation. 2012; Online.
![Page 35: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/35.jpg)
Valve in Valve
JACC 2017. 69:2253-62
![Page 36: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/36.jpg)
Valve in Mitral
CASE
![Page 37: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/37.jpg)
Pulmonic Valve Replacement
CASE
![Page 38: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/38.jpg)
• Low Risk Trial PARTNER 3 (Corevalve low
Risk) currently enrolling.
• Bicuspid Valve disease.
• PCI/TAVR versus AVR/CABG.
• Moderate AS in setting of LV dysfunction
(TAVR-UNLOAD).
Future of TAVR
![Page 39: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/39.jpg)
• Mitral Clip
• New valve replacement technologies
• New valve “repair” technologies
Transcatheter Mitral Valve Therapies
Carpentier Classification of mitral regurgitation
![Page 40: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/40.jpg)
Mitraclip
• FDA approved for treatment of
“degenerative” mitral valve disease in
those at high surgical risk
• High risk: >6% mirtal valve repair or
>8% for replacement
• COAPT trial: treatment of functional
MR in patients with LV dysfunction
• Continued Access COAPT registry
![Page 41: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/41.jpg)
Mitraclip
CASE
![Page 42: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/42.jpg)
TMVR
• Mitral valve position
• Valve sealing
• Obstruction of the LV outflow tract
• Delivery system
• Anchoring and retention
• Complex mitral valve anatomy
JACC 2017. 69:2175-92.
![Page 43: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/43.jpg)
TMVR
Tendyne Intrepid
JACC 2017. 69:2175-92.
![Page 44: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/44.jpg)
TMVR
JACC 2017. 69:2175-92.
![Page 45: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/45.jpg)
ANCORA/ACCUCINCH
JACC 2013. 4:1-13.
![Page 46: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/46.jpg)
Case XX
![Page 47: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/47.jpg)
• Transcatheter aortic valve replacement has been
transformative for the care of patients with Severe
AS.
• Refinements in technology has improved care.
• Mitral Valve disease is the new frontier in
structural heart disease.
Conclusion
![Page 48: Transcatheter Valve Replacement: Current State in 2017€¦ · 2.2% 1.7% No Any Stroke 3.4% 5.6% No Pacemaker 25.9% 6.6% Yes Vascular Complication 6.0% 1.1% Yes SURTAVI 30 day Outcomes](https://reader033.vdocuments.mx/reader033/viewer/2022042908/5f3986adf3cce126274536f6/html5/thumbnails/48.jpg)
Questions
314-747-3617
Marc A. Sintek MD
Assistant Professor of Medicine
Interventional Cardiology
Cardiovascular Division
Washington University in St. Louis