Thay van động mạch chủ qua da trên bệnh nhân đông nam á (transcatheter aortic valve implantation the malaysian experience)

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ROSLI Mohd AliHead

Department of CardiologyNational Heart Institute

Kuala Lumpur

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31% of patients with severe

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Edward Sapien Valve

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CoreValve

Self-expanding nitinol frame & porcine pericardiumLength 50 mm, 18 Fr = 6 mm

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Evolution of Self-Expanding TAVI

The CoreValve clinical experience includes three product generations:

• 1st generation (25F) - Proof of concept

• 2nd generation (21F) - Safety & efficacy study

• 3rd generation (18F) - Safety & efficacy study + Post CE Registry

Evolution to Truly Percutaneous AVR

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ProSTAR (Abbott)

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1st Patient – Femoral Artery Access

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Partner Cohort B

50.7%

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Partner Cohort A

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Patient Selection is Critical !TAVI

Need to ensure a successful programmePatient safety & clinical benefits

Outcome data (under scrutiny)Cost issues (funding)

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TAVIClinical AssessmentSevere symptomatic ASElderly age groupGeneral condition

General well being before being symptomatic

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Echocardiography (required)

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Annulus – LVOT measurement

annulusLVOT

height

Annulus diameter 20 – 27 mm

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Coronary Angiogram

Severe stenosis in proximal segment Should be treated prior to TAVI

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IJN Experience:Baseline characteristics (n=16) •VariablesPatientsMean age76 ± 4 Sex male (%)13 (81%)

Mean body mass index25.98 ± 8

Coronary artery disease10 (62.5%)

Hypertension10 (62.5%)

Diabetes Mellitus3 (18.8%)

Chronic renal failure2 (12.5%)

Anaemia + Chronic Myeloid Leukaemia3 (18.8%)Others (chronic lung disease, previous

cancer, Atrial Fibrillation, Myaesthenia

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Baseline characteristics

VariablesNo

Mean functional class (NYHA)2.3 ± 0.8Echo :

Mean aortic valve area (cm)0.57 ± 0.13 Mean aortic peak gradient

(mmHg)

97 ± 28

Mean ejection fraction (%)61 ± 8

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Conclusions

•The transcatheter aortic valve replacement

programme requires a dedicated & committed TEAM approach

•Attention to detail at every juncture is crucial

for a successful programme

•Has a steep and in-depth learning curve