TAVIBETWEEN DREAMS

AND REALITY

Aortic valve replacement

Refused for SurgeryEuro Heart Survey on Valvular Heart Disease (5001 Patients)

32 % did not undergo

surgery !Iung B. and al, Eur. Heart Journal 2003 : 24, 1231-1243

But cardiologists never lose the hopeInterventional Cardiology

‘Credo’“Anything a cardiac

surgeon can do,

an interventional cardiologist

can do

as well or better

percutaneously”

AH Gershlick, 2003

First human implantation: Alain Cribier

April 16, 2002 ( France)

Bovine pericardium valve23mm in diameter

• Vascular access– Sites

• Transfemoral• Transapical

– Left ant. thoracotomy– More direct, shorter catheter– Septal hypertrophy– Ascendra2, Sapien valve

• Transaortic – Upper partial sternotomy– Mini-sternotomy 2/3 RICS– Aorta 5 cm above valve– Less painful, familiar approach– Manipulation of ascending aorta

• Subclavian

Percutaneous or Cut-down technique

And recently the ongoing dream

“Feasibility trial” reports deployment of new device for TAVI in aortic insufficiency23 May 2013, Paris, France: A new investigational device - the Helio System (TF-FA) - being developed for use with the Sapien XT Transcatheter Heart Valve was successfully deployed in all four patients in a small, first-in-human feasibility study of its use in high-risk aortic insufficiency reported at EuroPCR 2013. there were no in-hospital deaths. One patient had a stroke/TIA and one suffered minor vascular complication. One patient, who had pre-existing renal impairment, had an acute kidney injury. The primary endpoint of freedom from all-cause mortality at 30 days was 100% all four patients were alive at one year. Aortic insufficiency improved from moderate to severe before the procedure to trivial at 30 days. Two patients followed up at 12 months had no aortic insufficiency at this time point.