Severe Aortic Valve Disease: TAVR in Four Ages and Four Etiologies Age 25 y/o Congenital, 50 y/o Bicuspid, 75 y/o Rheumatic, 100 y/o Degenerative Samin K. Sharma, MD, FACC, FSCAI Director Clinical & Interventional Cardiology President Mount Sinai Heart Network Dean, International Clinical Affliliations Anandi Lal Sharma Professor of Medicine (Cardiology) Cardiovascular Institute Mount Sinai Hospital, New York COI: No relationship to disclose for this presentation
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Severe Aortic Valve Disease:TAVR in Four Ages and Four Etiologies
Pt with prohibitive surgical risk are appropriate For TAVR even with low STS risk:- hostile mediastinum, egg-shell aorta, RT- prior CABG with IM stuck to mediastinum- severe COPD, extreme frailty
FDA approved two RCT of low risk AS for both Sapien-3 and Evolut-R vs SAVR are ongoing
Recommendations for Choice of Interventions in AS
Nishimura et al., J Am Coll Cardiol 2017;70:252
I
SURTAVI
TAVR in Bicuspid Aortic Valve DiseaseClinical Outcomes
Mylotte et al., J Am Coll Cardiol 2014;63:2330
0
10
20
30
40
Mortality Stroke Bleeding Vascularcomplications
Newpacemaker
17.5
2.2
26.6
21.623.2
20.8
2.1
16.7
12.5
16.7
12.5
2.2
31.9
26.4 26.7
%
p=0.12
p=0.99
p=0.07 p=0.08 p=0.21
All patients (n=139) Sapien (n=48) CoreValve (n=91)
TAVR in Evolution (2017+)Future Clinical Indications