#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
#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
#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%
#EACTS2021

Significantly more mild or moderate PVL with Corevalve system at 30days, which was the same as Sapien system by 1 year

Significantly lower mean gradient with Corevalve system at 30days, same as Sapien 3 by 1 year
#EACTS2021

Limitation of this study is reliance on the TVT database - what I was not clear about is why these patients could not have surgery. Anyway, one assumes there was an MDT discussion in each case and surgery was not deemed feasible?

@GilbertTangMD
#EACTS2021

I think that was a point the panel were keen to make, that a single retrospective study could not be used to suggest that TAVI in very large annuli is 'ready for prime time', but that these important results do give some confidence if a patient cannot undergo surgery

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More from @dr_benoy_n_shah

15 Oct
#EACTS2021

This 🧵is related to Thursday's symposium on Edwards' Inspiris Resilia aortic bioprosthetic valve

The hospital in which I work used this valve for ~2yrs before stopping, so I was intrigued to hear the experts

A thought-provoking session!
@rafasadaba @GilbertTangMD Image
#EACTS2021

First talk from Prof Takkenberg, who needs no introduction to any of you. A very important talk in which she questioned the primacy of RCTs and spoke up on the importance of 'real world' registry data, often dismissed as poor quality Image
#EACTS2021

I learnt a new acronym today - GOBSAT!
Good Old Boys Sat Around the Table!
i.e. expert consensus, LoE - C! Love it!

She emphasised that a lot of our evidence, esp in VHD, is GOBSAT!

@mirvatalasnag @mrjzacharias ImageImage
Read 29 tweets
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!
#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
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!
#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
Read 25 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
13 Oct
#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
Read 14 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

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