Ε. Βαβουρανάκης Αναπλ. Καθηγητης Καρδιολογίας Adjunct Professor Ohio State University, USA

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1 Ε. Βαβουρανάκης Αναπλ. Καθηγητης Καρδιολογίας Adjunct Professor Ohio State University, USA

2 Ενδείξεις

3 Στένωση Αορτικής Βαλβίδας Επίπτωση Aποτελεί σήμερα μια από τις πιο συχνές επίκτητες βαλβιδοπάθειες στον δυτικό κόσμο Ένα 4,6% του πληθυσμού των ενηλίκων 75ετών υπολογίζεται ότι πάσχει από σοβαρού βαθμού στένωση της αορτικής βαλβίδας Iung B European heart journal Jul;24(13)

9 Figure 2 Clinical Decision Making Process in Low LVEF, LF-LG Severe AS Dobutamine stress echocardiography (DSE) is useful to assess LV flow reserve and to distinguish between the true severe and pseudosevere AS. Quantification of valve calcifica... Philippe Pibarot, Jean G. Dumesnil Low-Flow, Low-Gradient Aortic Stenosis With Normal and Depressed Left Ventricular Ejection Fraction Journal of the American College of Cardiology Volume 60, Issue

11 Outcome of Patients with Paradoxical Low-Flow, Low-Gradient AS Eleid et al. Circulation 2013

12 Survival by stroke volume index in patients with low-gradient normal LVEF severe aortic stenosis Eleid et al. Heart

13 From: THE VALVULOARTERIAL IMPEDANCE AS A PROGNOSTIC FACTOR IN PATIENTS WITH AORTIC STENOSIS J Am Coll Cardiol. 2012;59(13s1):E2022-E2022. doi: /s (12) Figure Legend: = (systolic arterial pressure + mean transvalvular gradient) by the stroke volume indexed for the body surface area. Kaplan-Meier cardiac event free survival curve in patients with aortic stenosis stratified into 3 groups according to valvuloarterial impedance Date of download: 10/10/2014 Copyright The American College of Cardiology. All rights reserved.

14 From: THE VALVULOARTERIAL IMPEDANCE AS A PROGNOSTIC FACTOR IN PATIENTS WITH AORTIC STENOSIS J Am Coll Cardiol. 2012;59(13s1):E2022-E2022. doi: /s (12) Figure Legend: = (systolic arterial pressure + mean transvalvular gradient) by the stroke volume indexed for the body surface area. Kaplan-Meier cardiac event free survival curve in patients with aortic stenosis stratified into 3 groups according to valvuloarterial impedance Date of download: 10/10/2014 Copyright The American College of Cardiology. All rights reserved.

15 Impact of AVR on Survival in Patients with Paradoxical Low-Flow, Low-Gradient AS Clavel et al. JACC

16 Επιλογή των ασθενών

17 Συμπτωματική Στένωση αορτικής βαλβίδας. 1. Υψηλού χειρουργικού κινδύνου ασθενείς High risk for surgery 2. Ανεγχείρητοι ασθενείς - Inoperable 3. Ενδιαμέσου χειρουργικού κινδύνου ασθενείς - Low risk for surgery 4. Ειδικές περιπτώσεις - Special groups

22 Examples of major organ system compromise: Cardiac severe LV systolic or diastolic dysfunction or RV dysfunction, fixed pulmonary hypertension; CKD stage 3 or worse; pulmonary dysfunction with FEV1 <50% or DLCO 2 <50% of predicted; CNS dysfunction (dementia, Alzheimer's disease, Parkinson's disease, CVA with persistent physical limitation); GI dysfunction Crohn's disease, ulcerative colitis, nutritional impairment, or serum albumin <3.0; cancer active malignancy; liver any history of cirrhosis, variceal bleeding, or elevated INR in the absence of VKA therapy.

23 Examples Tracheostomy present, Heavily calcified ascending aorta, Chest malformation, Arterial coronary graft adherent to posterior chest wall, Radiation damage.

25 Seven FRAILTY indices Katz Activities of Daily Living : Idependence in feeding, bathing, dressing, transferring, toileting, and urinary continence and independence in ambulation (no walking aid or assist required or 5-meter walk in <6 s).

41 Συμπτωματική Στένωση αορτικής βαλβίδας. 1. Υψηλού χειρουργικού κινδύνου ασθενείς High risk for surgery 2. Ανεγχείρητοι ασθενείς - Inoperable 3. Ενδιαμέσου χειρουργικού κινδύνου ασθενείς - Low risk for surgery 4. Ειδικές περιπτώσεις - Special groups

48 Επιλογή των ασθενών Ανατομικές παράμετροι

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52 First transcatheter aortic valve implantation with the CoreValve Evolut-R retrievable and repositionable bioprosthesis in Greece with the InLine sheath and the En veo loading guiding catheter : a major advantage for small diameter access vessels. (Under Review) SIZE14F

53 Evolut-R retrievable and repositionable bioprosthesis with the InLine sheath

56 TRANSAORTIC LATERAL THORACOTOMY IMPLANTATION HIPPOKRATION HOSPITA L ATHENS CARDIAC SURGEONS AND INTERVENTIONAL CARDIOLOGISTS : HEART TEAM

59 ACURATE neo & ACURATE TF Delivery System New Site Training Presentation Module II TQP810506rev4 New Site Training

60 ACURATE neo/tf Procedure Steps Step 1 Open upper crown Maintain pressure at a fixed point to keep delivery system on outer curvature of arch

78 Edwards

79 Edwards

80 Lotus

81 Lotus

82 symetis

83 symetis

84 symetis

85 TAVI Αλλάζουν οι ενδείξεις ; Επεκτείνονται Ο Αλγόριθμος για την Επιλογή των ασθενών : Διευρύνεται με Λεπτομερή αξιολόγηση ολων των Παραμέτρων

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