Thread by @dr_benoy_n_shah

#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!

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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

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Retrospective study looking at everyone age >90 that had TAVI & then matched them to the Quebec general population that are >90 years

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I love it when we see tables like this and the presenter says "As you can see..." No, I can't see! 😆

75% Balloon-expandable THV
25% Self-expandable THV
Mortality 11/171 (6%); stroke 9/171 (5%); new LBBB 22/171 (13%)

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Here are the univariable & multivariable Cox regression analyses & KM curve suggesting a significant survival advantage for those undergoing TAVI

Thought provoking...

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So, the conclusion was that nonagenarians should not be denied TAVI on lack of prognostic benefit grounds

My thought is...what if high gradient severe AS but no symptoms? In our centre, an asymptomatic pt >90 would not get TAVI...what would you do in your hospital?

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Next talk from @Claudmuneretto on the important issue of patients with small aortic annuli - should they have a sutureless / rapid deployment valve or a TAVI?

@GilbertTangMD @mrjzacharias

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Starts by reminding us of the issues with small aortic annuli, including high risk of patient prosthesis mismatch

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Retrospective study

Oh no...more propensity score matching. Let's just move on...

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Less PVL & less need for pacemakers in patients with sutureless valves

After some statistical gymnastics (aka matching), there appears to be increased PPM with TAVI compared to sutureless valves also

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Conclusions - Sutureless bioprostheses may be superior to TAVI in these patients with small aortic annuli

So...what do I think? I think we need...a randomised study! Maybe one is already underway, I don't know...

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Next talk from @MMarinCuartas looking at outcomes when performing SAVR after a prior TAVI

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A single-centre retrospective analysis of 28 patients

Main reason for re-intervention was endocarditis - important to remember this, TAVI valves are biological valves and they get infected too, just like surgical bioprostheses

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Median time from TAVI to AVR was just 7 months...I guess some of these valves may have had bacterial entry into the body at the time of the TAVI procedure?

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Overall mortality ~14%

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Conclusions

SAVR after TAVI is feasible, but (obviously) carries high risk.

The most common reason for repeat intervention is endocarditis

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Next, an interesting talk from @JohannPetersen looking at physical & mental recovery after SAVR and TAVI

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A *prospective* study! Well done!

This is how physical and mental recovery were assessed

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Mean age ~73-75yrs
Here are physical & mental recovery slides - I interpreted the 6MWT graph as this being greater for SAVR than TAVI? Unsure if y axis is change (delta) in 6MWT distance or absolute distance...

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Here are Dr Petersen's conclusions

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Next, a comparison of ProGlide versus surgical cutdown in TF TAVI from Dr Jan Rychter (Poland)

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Here are the study objectives and their methodology - this is data from a national (POLTAVI) registry

As you can see, large numbers in each group

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Mean age 79yrs
~20% have peripheral arterial disease
I missed the main results slide (!), here's the bleeding data

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Must commend the speaker for including a limitations slide; very important to acknowledge this for these retrospective studies in which inevitably there will be biases that cannot be corrected, even by PSM!

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Next, a meta-analysis of LA versus GA for TAVI from Dr Cheng (China)

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I think most of us have now moved over to LA rather than GA, certainly in most UK centres that is true

Still, here's their methods...

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FELLOWS / RESIDENTS - please DON'T do this!

I understand there may be a limitation on number of slides and on time but...

what am I supposed to read from this?!

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Here is their conclusion

In my hospital, we only use GA for the rare transapical case or for TF cases where surgical cut-down is needed or other reasons like patient would not tolerate sedation / LA approach

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Final presentation on the Royal Brompton's experience using the Tendyne TMVI system - hope you saw my thread last night on the TMVI session, so you should be up to speed with what this is! 😀

@GilbertTangMD

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The Royal Brompton has a large experience with the Tendyne system, here we saw their data

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Retrospective analysis of their 26 patients that had a Tendyne procedure between 2014-2020

24/26 had secondary MR

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High-risk cohort, by all accounts...

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Here are their results...

Significant reduction in PA pressures, no change in LV cavity size or LV EF

Improvement in NYHA status

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52% survival at 3yrs; some patients died last year due to COVID-19 (may still be alive otherwise)

For patients that cannot have surgery or TEER, I think these are encouraging results...

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Phew...the end!

😀