Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

The huge opportunities for transcatheter aortic valve implantation

01.09.2009
Professor Dominique Himbert

30 August: "Today, transcatheter aortic valve implantation (TAVI) represents an effective therapeutic alternative to conventional aortic valve replacement for patients who are at high risk or with contraindications to surgery, and the combination of the transfemoral and transapical approaches further increases the number of patients who can be treated" said Prof Dominique HIMBERT from the Bichat Hospital in Paris France, at a press conference at the ESC Congress in Barcelona.

"Degenerative aortic stenosis represents a serious and growing public health problem, with regard to the demographic trends expected in the next decades. It should be addressed with appropriate resources to treat a larger number of elderly patients at high-risk or with contraindications to conventional cardiac surgery. These interventions should be less invasive than surgery, less influenced by patients' comorbidities, and allow shorter hospital stays and faster recovery" concluded Prof Himbert.

Transcatheter aortic valve implantation (TAVI) is an emerging technique offering the possibility of restoring a normal aortic valve function in patients with severe aortic stenosis, without removing the native valve, on a beating heart, without cardiopulmonary bypass and sternotomy. The prosthesis can be implanted via either a transfemoral approach, like in standard cardiac catheterization, or a transapical approach, using a direct puncture of the left ventricule. Whatever the access used, this technique allows patients who are at very high surgical risk or with contraindications to conventional surgery to benefit from an effective treatment of aortic stenosis. A strategy integrating the transfemoral and the transapical accesses increases the number of patients who can be treated. One-year results are satisfactory in terms of survival and functional improvement, in particular given the patients' risk profile. The most important predictor of late survival is the experience of the medical team, which underlines the necessity of proper training and the restriction of these procedures to high-volume centers.

Degenerative calcified aortic stenosis is the most frequent valve heart disease in Europe and Western countries. Its prevalence increases with age. Mild to severe aortic stenosis is present in 2 to 4% of adults over 65 years. After the onset of symptoms, average survival is 2 to 3 years with a high risk of sudden death. Surgical aortic valve replacement is the reference treatment, leading to 60 000 operations every year in the European Union. However, one third of candidates are denied surgery, particularly in the elderly, because of a perceived high operative risk due to comorbidities, or technical contraindications to surgery. Feasibility and short-term outcomes of TAVI techniques have been demonstrated in these high-risk subsets, but mid- and long-term results need to be evaluated.

The present single-centre study reports the short and mid-term outcomes of 120 patients consecutively treated by TAVI between October 2006 and June 2009. All of them suffered from a very severe and symptomatic aortic stenosis, and multidisciplinary medicosurgical consensus concluded that they had an unacceptably high operative risk or absolute contraindications to surgery.

An anatomical evaluation using echocardiography, angiography and computed tomography was used to define the technical feasibility of TAVI, the approach (transfemoral or transapical) and the type of prosthesis to be used (Edwards SAPIEN THV [balloon expandable] or CoreValve Revalving System [self expandable]). On average, patients were 81 years old, more than half of them had at least 2 severe extracardiac comorbidities, and their estimated operative mortality was comprised between 16% and 27%, according to the predictive risk score used. The risk profile tended to be even more severe in the transapical group than in the transfemoral.

The prosthesis was successfully implanted in 96% of the cases. The most frequent complications were vascular (10%), due to the large diameters of the femoral sheaths, and heart blocks necessitating definitive cardiac pacing (9%). Strokes were rare (3%). Overall, procedural mortality was 3%, and 30-day mortality 9%: 8% in the transfemoral group, and 11% in the transapical group. At one year, overall survival was 79%. There was no statistically significant difference between the transfemoral (83%) and the transapical group (69%). The most important predictor of late mortality was related to the learning curve, involving the patients' selection process, the procedural technique itself, and post-operative care. One-year survival was 60% in the first 25 patients, compared to 85% in the last 95, and this difference was statistically significant in uni- and multivariate analysis. Most important, 87% of the survivors returned to normal life, with no or only mild residual symptoms.

Today, TAVI represents an effective therapeutic alternative to conventional aortic valve replacement for patients who are at high risk or with contraindications to surgery, and the combination of the transfemoral and transapical approaches further increases the number of patients who can be treated. In the future, randomized controlled trials and comprehensive registries with longer follow-up will help to better define the safety and the durability, and subsequently, indications of the technique and the respective places of the transfemoral and transapical approaches.

Jacquelline Partarrieu | EurekAlert!
Further information:
http://www.escardio.org

More articles from Medical Engineering:

nachricht Novel breast tomosynthesis technique reduces screening recall rate
21.02.2017 | Radiological Society of North America

nachricht Biocompatible 3-D tracking system has potential to improve robot-assisted surgery
17.02.2017 | Children's National Health System

All articles from Medical Engineering >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Breakthrough with a chain of gold atoms

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

Im Focus: DNA repair: a new letter in the cell alphabet

Results reveal how discoveries may be hidden in scientific “blind spots”

Cells need to repair damaged DNA in our genes to prevent the development of cancer and other diseases. Our cells therefore activate and send “repair-proteins”...

Im Focus: Dresdner scientists print tomorrow’s world

The Fraunhofer IWS Dresden and Technische Universität Dresden inaugurated their jointly operated Center for Additive Manufacturing Dresden (AMCD) with a festive ceremony on February 7, 2017. Scientists from various disciplines perform research on materials, additive manufacturing processes and innovative technologies, which build up components in a layer by layer process. This technology opens up new horizons for component design and combinations of functions. For example during fabrication, electrical conductors and sensors are already able to be additively manufactured into components. They provide information about stress conditions of a product during operation.

The 3D-printing technology, or additive manufacturing as it is often called, has long made the step out of scientific research laboratories into industrial...

Im Focus: Mimicking nature's cellular architectures via 3-D printing

Research offers new level of control over the structure of 3-D printed materials

Nature does amazing things with limited design materials. Grass, for example, can support its own weight, resist strong wind loads, and recover after being...

Im Focus: Three Magnetic States for Each Hole

Nanometer-scale magnetic perforated grids could create new possibilities for computing. Together with international colleagues, scientists from the Helmholtz Zentrum Dresden-Rossendorf (HZDR) have shown how a cobalt grid can be reliably programmed at room temperature. In addition they discovered that for every hole ("antidot") three magnetic states can be configured. The results have been published in the journal "Scientific Reports".

Physicist Dr. Rantej Bali from the HZDR, together with scientists from Singapore and Australia, designed a special grid structure in a thin layer of cobalt in...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Booth and panel discussion – The Lindau Nobel Laureate Meetings at the AAAS 2017 Annual Meeting

13.02.2017 | Event News

Complex Loading versus Hidden Reserves

10.02.2017 | Event News

International Conference on Crystal Growth in Freiburg

09.02.2017 | Event News

 
Latest News

From rocks in Colorado, evidence of a 'chaotic solar system'

23.02.2017 | Physics and Astronomy

'Quartz' crystals at the Earth's core power its magnetic field

23.02.2017 | Earth Sciences

Antimicrobial substances identified in Komodo dragon blood

23.02.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>