Dr. Jean Fajadet,
Bernard Iung began his presentation by showing the growing use of TAVI (>30 000 implanted) and explained the issues of a proper patient selection for TAVI. He emphasized the problem of identifying high risk patients: the scores used in routine practice are not adapted to predicting the risk of the procedure especially in high risk patients. Frailty, comorbidities, functional and cognitive capacities are identified as major criteria of prognosis. He explained the major criteria (clinical, angiographic, echocardiographic) needed for patient screening and selection and the need for a multidisciplinary approach.
Thomas Walther showed results from the German registry with an increasing rate of TAVI up to 23.9% in 2010 associated with a stable to mild reduction of surgical aortic valve replacement.he focused on the predictors of complications (left main compression by excessive cusp calcification, risk of stroke…during TAVI procedures. He differentiated screening and selection of patients, all comers and selection, and insisted on the risk of patients on waiting list. He showed the new generation of percutaneous valves which could reduce complication rate.
Phil MacCarthy demonstrated the importance of patient selection, determination of risk profile which is unique for each patient, clinical judgement, multidisciplinary approach and the heart team. He defined what can we call on-label and off label (patient with inaccurate score calculation, bicuspide valve, severe mitral regurgitation, valve in valve intervention, prior mitral valve prosthesis) insisting on different issues of off-label indication.
Volker Falk concluded this excellent session showing indications, technique, technical refinements and very positive results of surgical transapical approach.
Controversial issues in transcatheter aortic valve implantation
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