TAVR - CACI

TAVR :
Argentinian Registry
Dr. Alejandro Cherro
Colegio Argentino de Cardioangiólogos Intervencionistas.
Buenos Aires, Argentina
I do not have any conflict of interests.
Argentinian Registry TAVR: 35 Institutions
CORDOBA
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SANATORIO ALLENDE
HOSPITAL PRIVADO DE LA COMUNIDAD
FUSAVIM
HOSPITAL DE CORDOBA SANATORIO
VELEZ SARSFIELD CLINICA SUCRE
SANTA FE
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INSTITUTO DE DIAGNOSTICO SANTA FE
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SANATORIO GARAY
ROSARIO
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INSTITUTO CARDIOVASCULAR ROSARIO
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SANATORIO PLAZA
HOSPITAL ITALIANO
CORRIENTES
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INSTITUTO DE CARDIOLOGIA CABRAL
BUENOS AIRES
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FUNDACION FAVALORO
HOSPITAL ALEMAN
HOSPITAL BRITANICO DE BS AS
HOSPITAL ESPAÑOL DE BS AS
HOSPITAL ESPAÑOL DE LA PLATA
HOSPITAL JUAN A FERNANDEZ
HOSPITAL ITALIANO DE BS AS
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INSTITUTO CADIOVASCULAR DE BS AS
INSTITUTO MOD. DE ALTA COMPLEJIDAD
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ANATORIO BURZACO
SANATORIO GUEMES
SANATORIO OTAMENDI
HOSPITAL DEL CRUCE
HOSPITAL DEL SUR BAHIA BLANCA
CLINICA SAN CAMILO
CLINICA ADVENTISTA
CLINICA SAGRADA FAMILIA
INSTITUTO FLENI
SANATORIO LAS LOMAS
SANATORIO TRINIDAD PALERMO
HOSPITAL UNIVERSITARIO UAI
%Evaluation Time:
Echocardiographic & Clinical Variables
30 D
6M
1Y
2Y
3Y
680 patients have been included in the
Registry, 509 patients have been studied for
this presentation
Retrospective / Prospective Registry
Consecutive TAVRs since March 2009
www.tavi.org.ar
In Argentina self-expanding prostheses with porcine pericardium
are used.
The Registry is independent of sponsors
Population Characteristics in TAVR and
SAVR
Age
TAVR 20092014
TAVR
Registry
509 Patients
35 Centers
SAVR
2007-2008
1996-1997
CONAREC 16
ESMUCICA
359 Patients
177 Patients
49 Centers
4 Centers
81,4
64,8
65,8
Femenine Sex
52,0%
36,8%
47%
Hypertension
89,0%
64,6%
N/D
Hypercholesterolemia
73,0%
36,7%
N/D
Diabetes
24,0%
17,5%
9,0%
23%
30%
N/D
20,84%
3.5% - 6.5%
Parsonnet Score
Current Smoker
Euro Score
Non-Cardiovascular Comorbidities in
TAVR vs SAVR
TAVR
TAVR Registry
509 Patients
Pulmonary Hypertension
Chronic Renal Failure / Dialysis
EPOC
SAVR
CONAREC 16
359 Patients
ESMUCICA
177Patients
65,0%
-
-
18,0% / 2,0%
7,8% / 0,8%
2,8%
8,3%
-
27% /
Cirrhosis
3,0%
-
-
Chest Irradiation
1,5%
-
-
Characteristics in TAVR
Methodology: TAVR
120.0%
100.0%
Direct Aortic
Transapical
Subclavian
Femoral
Neuroleptoanalgesya
General
80.0%
60.0%
98.0%
95.0%
82.0%
40.0%
LC
CX
RC
26,7%
DA
20.0%
VIV
Native Valve
0.0%
Aortic
Stenosis
Previus PCI
Anesthesia
Vascular
Access
Methodology: TAVR
120.0%
23mm
100.0%
80.0%
3.0%
Two Valves
31 mm
31.0%
One Valve
26mm
60.0%
23 mm
97.0%
40.0%
69.0%
31 mm
29mm
20.0%
26 mm
0.0%
29 mm
Valvulaplasty
Valve Diameter
Valve Qty
Depth of
Implant
No
Yes
Results: TAVR
III
3.0%
3.0%
BCRI
100.0%
17.0%
II
90.0%
BAV
80.0%
FC III
70.0%
FC II
60.0%
97.0%
59.0%
I
50.0%
FC I
40.0%
Without
30.0%
18,4% PM
2.4%
20.0%
21.0%
0
10.0%
16.0%
No
Yes
0.0%
Success
Leak
Pacemarker
44% of pacemakers were implanted on patients with previous RBBB
Trans valvular Gradient Post TAVR
160
140
120
100
81.24
80
60
40
7
12
14
15
20
0
Pre
Post
30 dias
6 meses
12 mese
Mortality & Morbidity at 30 Days
Argentinian Registry TAVR
10.0%
9.0%
8.0%
7.0%
6.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
9.4%
4.8%
4.9%
3.9%
0.4%
5.3%
EuroScore Related Mortality
Population x EuroScore
100%
90%
80%
70%
60%
50%
40%
30%
20%
Mortality x EuroScore
Global
Mortality
4,43%
INOPERABLE
24,22%
10,20%
TAVR SELF EXPANDING
INOPERABLE LIKE
5,21%
3,57
10%
0%
< 10
10 a 19
>20 a 29
EuroScore EuroScore EuroScore
TAVR PARTNER B LIKE
> 30
Euroscore
Other Complications
4.50%
4.05%
4.00%
3.50%
3.00%
2.50%
1.92%
2.00%
1.50%
1.06%
1.06%
1.00%
0.42%
0.50%
0.00%
Convertion to
SAVR
Prosthesis
Migration
Pericardium
Bleeding
Annulus
Rupture
Aortic
Disection
Stroke (major&minor) 30 days
6
5
4.9%
4
4.6%
4.1%
4.0%
3.9%
3
2
1
0
UK-TAVI(1)
Adams et al(2)
Partner(3)
1NE Moat et al. J Am Coll Cardiol. 2011 Nov 8;58(20):2130-8.
2DH Adams et al. N Engl J Med. 2014 May 8;370(19):1790-8.
3RS Smith et al. N Engl J Med 2011;364:2187-98.
4-P Genereux et al. J Am Coll Cardiol 2012;59:2317–26.
Metanalysis(4)
Arg Reg
Permanent Pacemaker
30 days
25
20
21%
19.8%
18.4%
16.3%
15
13.9%
10
5
0
Koos et al(1)
UK-TAVI(2)
Adams et al(3) Metanalysis(4)
1-R Koos et al. J Heart Valve Dis. 2011 Jan;20(1):83-90 2-NE Moat et al.
J Am Coll Cardiol. 2011 Nov 8;58(20):2130-8.
3-DH Adams et al. N Engl J Med. 2014 May
8;370(19):1790-8.
4-P Genereux et al. J Am Coll Cardiol 2012;59:2317–26.
Arg Reg
Myocardial Infarction
30 days
2
1.5
1
1.3%
1.1%
0.5
0
UK-TAVI(1)
0.0
%
Partner(2)
0.6%
Metanalysis(3)
Arg. Reg.
1NE Moat et al. J Am Coll Cardiol. 2011 Nov 8;58(20):2130-8.
2RS Smith et al. N Engl J Med 2011;364:2187-98.
3-P Genereux et al. J Am Coll Cardiol 2012;59:2317–26.
All causes of Mortality
30 days
10
9
9.4%
8
7
6
7.8%
7.1%
5
4
3
3.4%
2
1
0
UK-TAVI (1)
Partner(2)
Metanalysis(3)
1NE Moat et al. J Am Coll Cardiol. 2011 Nov 8;58(20):2130-8.
2RS Smith et al. N Engl J Med 2011;364:2187-98.
3-P Genereux et al. J Am Coll Cardiol 2012;59:2317–26.
Arg Reg
All causes of Mortality 1 year Follow-up
30
25
24.3%
20
22.1%
21.4%
15
14.2%
14.1%
10
5
0
UK-TAVI(1)
Adams et al(2)
Partner(3)
Metanalysis(4)
1NE Moat et al. J Am Coll Cardiol. 2011 Nov 8;58(20):2130-8.
2DH Adams et al. N Engl J Med. 2014 May
8;370(19):1790-8.
3SK Kodali et al. N Engl J Med 2012;366:1686-95.
4-P Genereux et al. J Am Coll Cardiol 2012;59:2317–26.
Arg Reg
Argentinean Registry: TAVR
Preliminary Outcome
In-Hospital and 30 days FU
Any death
9,4%
Myocardial Infarction
0.6%
Stroke
3.9%
Permanent Pacemaker
18.4%
2.1 +/- 1.3 yrs of Follow-up
Any death
17.3%
Myocardial Infarction
0.8%
Any Stroke
4.1%
Death+Stroke
21.4%
All causes of Mortality
2 years Follow-up
40
35
33.9%
30
25
20
26.3%
15
17.3%
10
5
0
UK-TAVI(1)
Partner(3)
1-NE Moat et al. J Am Coll Cardiol. 2011 Nov 8;58(20):2130-8.
3-SK Kodali et al. N Engl J Med 2012;366:1686-95.
Arg
Reg
Conclusion
 The Argentinian TAVR Registry shows a not very
high mortality rate in high-risk and inoperable
patients at 2 years follow-up.
 New better devices for TAVR are showing a
reduction of severe and moderate valvular leaks.