Tag Archives: transcatheter aortic valve implantation

Several factors contribute to this treatment delay, including low patient awareness of the symptoms of valve disease, poor detection rates within primary care, limited access to diagnostic echocardiography, delayed referral to Heart Valve Clinics or Heart Centres, and prolonged waiting lists for surgical or transcatheter intervention.4–7 The prevalence of AS increases with age and typical symptoms, including breathlessness and dizziness, may be misinterpreted by primary care physicians as general signs of ageing rather than red flags for severe AS.6,8 In Europe, many patients are unable to access regular stethoscope checks to identify seve

Epidemiology of AS Prevalence AS is the most common valvular heart disease, accounting for 43% of valvular pathologies.1 Most cases are caused by calcification of the aortic valve leading to valve degeneration (termed calcified aortic valve disease [CAVD]), but rheumatic disease and congenital defects may also be responsible.8,9 The number of CAVD cases worldwide has been estimated at 9.4–12.6 million,9,10 although this may be an underestimate since many cases are asymptomatic and remain undiagnosed.11 Prevalence is particularly high in regions with a high sociodemographic index, including Europe, North America and Australasia, possibly re

Coronary intervention – Trials As the first ever blinded, sham-controlled, percutaneous coronary intervention (PCI) trial, demonstrating a non-statistically significant increase in exercise time at six weeks from PCI over optimal medical therapy (OMT), to say the publication of ORBITA (Percutaneous Coronary Intervention in Stable Angina) last year caused a stir would be quite the understatement. Regardless of your interpretation of the data,1 or ensuing hyperbole,2 unanswered questions certainly remained. Presentation of the previously blinded, invasive physiology data in the opening late-breaking clinical trials session here was therefore

A pathologist’s eye view of valve disease started the day with a presentation from Professor Kim Survana (Consultant Pathologist, Sheffield Teaching Hospitals NHS Trust). Covering the range from normality, to degenerative, calcific, rheumatic, congenital and infective pathology, slides of macroscopic and microscopic specimens brought to life what cardiologists see and hear in their daily practice, or as Professor John Chambers (Consultant Cardiologist, St Thomas’s Hospital, London) coined: “the reality of shadows”. Reviewing culture negative endocarditis, Dr John Klein (Consultant Microbiologist, Guy’s and St Thomas’s NHS Foundati

Introduction Figure 1. View at time of implantation demonstrating a newly deployed JenaValveTM in a patient with a Medtronic-Hall disc valve in the mitral position Transcatheter aortic valve implantation (TAVI) has become standard of care for patients with severe aortic stenosis at prohibitive operative risk for surgical aortic valve replacement (SAVR).1 The first randomised-controlled trial of TAVI stipulated the presence of a mitral valve prosthesis as an exclusion criterion for enrolment in the trial.2 The main reason was concern that dysfunction of the mitral valve prosthesis might arise during TAVI valve deployment.3 Further concerns wer

Anaemia was one of several problems chosen for a case-based discussion in a session on common non-cardiac co-morbidities. Dr Callum Chapman (West Middlesex University Hospital) presented the case of an elderly patient with known coeliac disease who had undergone transcatheter aortic valve implantation, which resulted in a paraprosthetic leak and impingement of the mitral valve. Unfortunately despite medical management of the leak she presented to the elderly care service in New York Heart Association (NYHA) Class III heart failure and was extremely oedematous. Blood tests revealed an iron deficiency anaemia and a reduced transferrin saturati

Introduction The provision of cardiopulmonary bypass (CPB) equipment and cardiothoracic (CT) surgical back-up during transcatheter aortic valve implantation (TAVI) has major implications for surgical services. Consensus statements from the Society of Cardiothoracic Surgery (SCTS) and the British Cardiovascular Intervention Society (BCIS) recommend that centres performing TAVI should have “immediate availability of perfusion services in case of the need for emergency bypass”, and that this, together with other criteria, mean that TAVI should only be performed in units currently performing surgical aortic valve replacement. There has, howev

PARTNER: transcatheter valves just as good as surgery for high risk aortic stenosis Transcatheter aortic valve implantation (TAVI) is just as effective at reducing mortality as surgery for severe aortic stenosis in elderly patients whose age and overall health posed high risks for conventional surgery, according to the results of the PARTNER (Placement of AoRTic TraNscathetER Valve trial). However, stroke rates were higher in the trancatheter group. The transcatheter approach involves delivering a bioprosthetic valve to its target location with a catheter using either transfemoral access or trans-apical access (through the ribs) if peripheral