#EACTS2021

Great first day. My favourite presentation was on the Carmat Total Artificial Heart (C TAH), presented by Professor @netuka_ivan

@rafasadaba
#EACTS2021
The C TAH is probably the world's most advanced total artificial heart & is designed for patients with severe biventricular failure (i.e. for whom an LVAD would be insufficient).

It gained a CE mark last year and has an FDA approval for early feasibility studies
#EACTS2021

The device has an implantable prosthesis and an external power supply to which it is constantly connected
#EACTS2021

C TAH has 2 chambers, separated by a membrane into blood & fluid compartments. Electro-hydraulic pumps help produce pulsatile flow. Pressure sensors & electronics are embedded in the prosthesis. Biological valves are placed at the inlets and outlets of the ventricles
#EACTS2021

Prof Netuka shared an example of a 61yr old patient with severe BiV failure and fixed pulm HTN that could not be weaned from IABP and inotropic support
#EACTS2021

Pre-operative cross sectional imaging required to ensure adequate dimensions for the prosthesis, which currently only comes in one size
#EACTS2021

We were then introduced to Prof Netuka's team and then had a video explaining the steps of the operation
#EACTS2021

Transect the aorta and pulmonary arteries!
#EACTS2021

As a cardiologist rather than a surgeon I can't really walk you through this, other than to say it was fascinating to me!
#EACTS2021

Getting the AV junctions ready
#EACTS2021

And now the 'heart'!
#EACTS2021

A Cardiomems device is placed as well to assist monitoring of pulmonary pressures
Well deserved round of applause at the end!

Eager to see where this technology goes. It's not new. I think Carmat started work on this in the early 1990s, initially a collaboration between Alain Carpentier & engineers from a subsidiary of Airbus. More tomorrow!

#EACTS2021
Any experience with this in 🇬🇧 transplant centres?

@drstephenpettit
#EACTS2021

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More from @dr_benoy_n_shah

15 Oct
#EACTS2021

Good morning everyone!

Spoilt for choice, unsure which session to attend but I am at Controversies in Transcatheter valve treatments

First talk is on TAVI in nonagenarians (>90 yrs old) - is there a survival benefit? by @RoxanneStL

Great and vital question! Image
#EACTS2021

If someone has already lived far past the average life expectancy in their country and is now into their 90s, can we *promise* the patient that TAVI will make them live longer?

In our centre, we feel that patients >90 need to be very motivated to have a procedure
#EACTS2021

Retrospective study looking at everyone age >90 that had TAVI & then matched them to the Quebec general population that are >90 years Image
Read 35 tweets
15 Oct
#EACTS2021

This is a 🧵all about Transcatheter Mitral Valve Implantation (TMVI). If you don't know a lot about this and want to learn more - read on! This is a summary of a great expert focus session

First talk from Dr Gry Dahle (Oslo), on why TMVI is not the same as TAVI
#EACTS2021

1st TAVI was done 10 years before 1st TMVI

TAVI has revolutionised treatment of aortic stenosis; TMVI is further behind largely due to anaromical complexity of treating the MV compared to the AV - the AV valves are much more complex than the semilunar valves! ImageImage
#EACTS2021

Historical timeline of the TMVI journey (left) and the large number of devices still competing for approval in the transcatheter mitral space (right)

@GilbertTangMD @mrjzacharias @BISMICS @SCTSUK @BrHeartValveSoc ImageImage
Read 25 tweets
14 Oct
#EACTS2021

Abstract session on Hot Topics in Transcatheter Therapies

Presentation from Dr Justin Robinson on use of TAVI in patients with very large aortic annuli - Results from the Michigan TAVI Quality Collaborative Image
#EACTS2021
Methods here: just over 200 patients with aortic annuli in excess of the normal ranges for both the Edwards Sapien and Medtronic Corevalve systems Image
#EACTS2021

This was not easy to read. Key data here:

Mean STS score ~5%
Device success ~95%
Pacemaker - 6% Sapien 3 vs 11% Corevalve (p<0.05)
In-hosp mortality ~2% Image
Read 6 tweets
14 Oct
#EACTS2021
Heart Team - does it still exist?

A very interesting session this morning - a 🧵
#EACTS2021
Dr Alfieri reminded us that medicine has a long history of collaboration between different specialties and areas of science/engineering

He gave the example of Lowell Edwards (engineer) & Albert Starr (surgeon) to create the ball-in-cage valve - same for Bjork-Shiley
#EACTS2021

Why do we have a Heart Team?

Dr Alfieri highlighted this can broadly be divided into these three categories. I really like this...
Read 21 tweets
4 Sep
This is a 🧵 about physical examination, and what role it (still) plays in modern clinical practice. Decided to write this after seeing a post earlier this yr by @RichardLehman1 on this issue and some people replying that examination was much less relevant in the modern era
I'd like to share 3 case examples of why I don't believe that is true. POCUS is a valuable *adjunct* to the initial clinical assessment, which includes both history & exam (H&E). The H&E should direct which tests you want & what Q you're asking

1. MR case
2. AS case
3. HF case
Case 1
Pt referred to @UHS_valveclinic with new murmur. Completely asymptomatic, very fit & active. Phys exam revealed a prominent systolic murmur, no other abN findings.

TTE images were hard...here is PLAX

@echo_stepbystep @iamritu @purviparwani @rajdoc2005 @mswami001
Read 23 tweets
22 May
1/ I know some of us have already had a brief discussion about this, but this is the most astonishing presentation I have seen in a long time.

We should discuss!

I must stress, I have *not* seen the actual presentation, I've seen the slides & write up on TCTMD only
2/ This study is derived from the TVT registry, looking at TAVIs with the Sapien 3/Ultra between 2015-2020

Of 159661 TAVIs, 37660 were in low risk patients (STS score <3%) & 3243 had bicuspid AV. They've propensity score matched to compare TAVI in BAV vs trileaflet AV valves
3/ Almost all the BAV pts made it into the propensity score-matched group (3168/3243 = 97.7%)

Mean age 69yrs
Mean STS score 1.7%
Mean LVEF 57%
Read 14 tweets

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