TAVI Trans-chateter Aortic Valve Implantation

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TAVITrans-chateter Aortic Valve Implantation
Hrvoje Stipic i Zvonimir Korda
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Aortic stenosis
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Aortic stenosis haemodynamic
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Aortic Stenosis is Life-thretening and Progress
Rapidly
Treatment Options and Timing Matter
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Mortality of Nonsurgically Treated Patients with
Severe AS
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AVR has become more common in the elderly
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Croatia is getting older
Lifetime expectancy at birth
men
women
men
women
2020
2050
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and this will continue...
Proportions of young, working and old population
in Croatia
men
women
men
women
2020
2050
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Potential AS population

• Croatia 4,5 million
• 20.000 with AS (0.5)
• 3200 severe AS (16)
• 1600 symptomatic (50)
• 480 do not undergo AVR (30)

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What do we currently have to offer?
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What did we have to offer?
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What do we currently have to offer?
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Patient selection or nonselection
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Risc Scores
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High Risc AVR Patients with Poor Outcomes
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What Do We Currently Have to Offer for High-Risc
Patients?
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TAVITrans-chateter Aortic Valve Implantation
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Dr. Alain CribierFirst in Man Pioneer
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Dr. Alain CribierFirst in Man Pioneer
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First in Croatia 2011 y.
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Evolution of Aortic Valve Implant
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TAVI Devices
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Core Valve
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Core Valve
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Core Valve
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Core Valve
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TAVI
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TAVI
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Core Valve Case Example
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TAVI- Numbers of Countries and Centers
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Potential population

• Croatia 4,5 million
• 20.000 with AS (0.5)
• 3200 severe AS (16)
• 1600 symptomatic (50)
• 480 do not undergo AVR (30)
• ? 200 TAVI candidates (50)

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TAVI
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My prediction Repetition of and Old Story
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Percutaneous Aortic Valve Prosthesis
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TAVI
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Con
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Pro
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TAVI ozracje 2010 g.
BDP
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TAVI cinjenice
TAVI VALVULA
KIR. VALVULA
TAVI VALVULA JE 20 PUTA SKUPLJA OD KIRURŠKE
VALVULE
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TAVI cinjenice 2

• TAVI skuplji nego kirurgija
• Cijena zahvata isplacena od osiguravatelja je
  ista
• TAVI mora biti jednako dobar ili bolji od
  kirurške zamjene aortalnog zalistka

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AVR 2010 vs 2011

• 2010 2011
• No. 104 90
• Dob 66.08 65.03
• Žene 41 (39.4) 31 (34)
• Muški 63 59
• EuroScore log. 6.69 6.71
• EF () 58.7 53.8
• ICU (stay/h) 67.22 72.4
• LOS (d) 9.21 12.45
• Smrtnost (30d) 1 (0,9) 1 (1,1)

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AVR 2010 vs 2011
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TAVI i KIRURGIJA

• zajednicki program kardiologije i kirurgije
• rješavanje najrizicnijih bolesnika
• ograniceni financijski resursi
• pocetak 2010
• sustavno provodenje od 2010 do 2012 godine

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AVR TAVI

• Izuzetno visok rizik za kirurgiju
• Porculanska aorta
• Child Pough B ili C
• Dob CABGAS
• Dob izbor bolesnika

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KARDIOLOGIJA
AVR KANDIDAT
TAVI KANDIDAT
KARDIOKIRURŠKI SASTANAK
Lista cekanja
AVR
TAVI
Odbijeni
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161 pt.
AVR kand. 76
TAVI kand. 24
KARDIOKIRURŠKI SASTANAK 161 pt.
AVR 56(90)
Lista cekanja AVR 24(39) TAVI 1.2 (2)
TAVI 10(17)
Odbijeni 2.4 (4)
Odbili op. 5.5 (9)
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TAVI vs ex TAVI kandidat

• TAVI ex.TAVI kan.
• No. 17 15
• Dob (g.) 81.1 81
• Žene 8 6
• Muški 9 9
• EF () 53.3 51
• ?p (sr) 56.3 58.6
• EuroScore log. 19.64 17.70

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TAVI vs ex TAVI kandidat

• TAVI ex. TAVI kan.
• AVR 17 9
• AVRCABG 0 6
• Reoperacija 0
  2
• ICU (h) 131,57 143,53
• LOS (d) 10.4 10.25
• Krvarenje 1
  1
• AI 2 6
  1
• Smrtnost (30d) 0 0
• Smrtnost (uk.) 2 0

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TAVI - INDIKACIJE

• INDIKACIJA n (17) dob
  (g.)
• Porculanska aorta 5
  78,83,85,84,78
• CABG 4
  74,78,84,76
• CABGresutura 1
  78
• Skolioza 1
  81
• Child Pough B, C 0 (2)
  0
• Dob izbor bol. 6
  76,86,83,89,81,85

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TAVI realnost

• Indikacija kirurški inoperabilni bolesnik
  (izuzetno visok rizik)
• Visoka dob ne znaci inoperabilitet.
• Ne postoji relevantna studija koja prati TAVI
  valvule duže od 5 godina.

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TAVI danas, sutra ???
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We are friends and we are the team !!
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• THANK YOU