Supra-aortic trunk TAVI - CACVS · 2020. 4. 29. · May 2009 –September 2017 104 transthoracic 87...
Transcript of Supra-aortic trunk TAVI - CACVS · 2020. 4. 29. · May 2009 –September 2017 104 transthoracic 87...
![Page 1: Supra-aortic trunk TAVI - CACVS · 2020. 4. 29. · May 2009 –September 2017 104 transthoracic 87 transarterial (83.9 % trans-subclavian and 16.1% transcarotid) Mortality lowered](https://reader035.fdocuments.in/reader035/viewer/2022071418/6115a0f7c811b409c00f3232/html5/thumbnails/1.jpg)
Supra-aortic trunk TAVI
Jacques TOMASI
![Page 2: Supra-aortic trunk TAVI - CACVS · 2020. 4. 29. · May 2009 –September 2017 104 transthoracic 87 transarterial (83.9 % trans-subclavian and 16.1% transcarotid) Mortality lowered](https://reader035.fdocuments.in/reader035/viewer/2022071418/6115a0f7c811b409c00f3232/html5/thumbnails/2.jpg)
Introduction
TF-TAVI is favoured
15-20 % non TF TAVI needed
Vascular complications as high as 6% in Partner 2
Transthoracic approaches developped first
Time of Transvascular non TF TAVI
First description of Trans carotid by Modineet al. 2010
![Page 3: Supra-aortic trunk TAVI - CACVS · 2020. 4. 29. · May 2009 –September 2017 104 transthoracic 87 transarterial (83.9 % trans-subclavian and 16.1% transcarotid) Mortality lowered](https://reader035.fdocuments.in/reader035/viewer/2022071418/6115a0f7c811b409c00f3232/html5/thumbnails/3.jpg)
![Page 4: Supra-aortic trunk TAVI - CACVS · 2020. 4. 29. · May 2009 –September 2017 104 transthoracic 87 transarterial (83.9 % trans-subclavian and 16.1% transcarotid) Mortality lowered](https://reader035.fdocuments.in/reader035/viewer/2022071418/6115a0f7c811b409c00f3232/html5/thumbnails/4.jpg)
Sizing and Planning
![Page 5: Supra-aortic trunk TAVI - CACVS · 2020. 4. 29. · May 2009 –September 2017 104 transthoracic 87 transarterial (83.9 % trans-subclavian and 16.1% transcarotid) Mortality lowered](https://reader035.fdocuments.in/reader035/viewer/2022071418/6115a0f7c811b409c00f3232/html5/thumbnails/5.jpg)
May 2009 – September 2017
104 transthoracic87 transarterial (83.9 % trans-subclavian and 16.1% transcarotid)
Mortality lowered in transarterial at 30 days but no difference at 1 yearComposite end-point 30-day (death, need for open, tamponade, stroke, major bleeding, AKI stage 2 or 3, coronary obstruction)25% vs 11.5 %Shorter lenght of stay 6 vs 7 days
![Page 6: Supra-aortic trunk TAVI - CACVS · 2020. 4. 29. · May 2009 –September 2017 104 transthoracic 87 transarterial (83.9 % trans-subclavian and 16.1% transcarotid) Mortality lowered](https://reader035.fdocuments.in/reader035/viewer/2022071418/6115a0f7c811b409c00f3232/html5/thumbnails/6.jpg)
Femoral vs non Femoral peripheral TAVI France TAVI
• 21611 patients
–92.5 % femoral (19,995 pts)
–7.5 % non femoral (1,616 pts)• 914 carotids
• 702 sub clavian
![Page 7: Supra-aortic trunk TAVI - CACVS · 2020. 4. 29. · May 2009 –September 2017 104 transthoracic 87 transarterial (83.9 % trans-subclavian and 16.1% transcarotid) Mortality lowered](https://reader035.fdocuments.in/reader035/viewer/2022071418/6115a0f7c811b409c00f3232/html5/thumbnails/7.jpg)
![Page 8: Supra-aortic trunk TAVI - CACVS · 2020. 4. 29. · May 2009 –September 2017 104 transthoracic 87 transarterial (83.9 % trans-subclavian and 16.1% transcarotid) Mortality lowered](https://reader035.fdocuments.in/reader035/viewer/2022071418/6115a0f7c811b409c00f3232/html5/thumbnails/8.jpg)
• Among peripheral vascular TAVR
– Similar results
– 2-fold lower rate of major vascular complications
– N-FP is safe reproducible, at least as good
![Page 9: Supra-aortic trunk TAVI - CACVS · 2020. 4. 29. · May 2009 –September 2017 104 transthoracic 87 transarterial (83.9 % trans-subclavian and 16.1% transcarotid) Mortality lowered](https://reader035.fdocuments.in/reader035/viewer/2022071418/6115a0f7c811b409c00f3232/html5/thumbnails/9.jpg)
• 8 trials 650 patients 2012-2017
• 364 trans carotid mortality 6.5 %, Strokes 3.8 %
• Vascular complications 7.7 %
• Alternative to other routes
![Page 10: Supra-aortic trunk TAVI - CACVS · 2020. 4. 29. · May 2009 –September 2017 104 transthoracic 87 transarterial (83.9 % trans-subclavian and 16.1% transcarotid) Mortality lowered](https://reader035.fdocuments.in/reader035/viewer/2022071418/6115a0f7c811b409c00f3232/html5/thumbnails/10.jpg)
• 50 first cases in Rennes
• No mortality
• 5 PPM (10%)
• 2% of AR > 2
![Page 11: Supra-aortic trunk TAVI - CACVS · 2020. 4. 29. · May 2009 –September 2017 104 transthoracic 87 transarterial (83.9 % trans-subclavian and 16.1% transcarotid) Mortality lowered](https://reader035.fdocuments.in/reader035/viewer/2022071418/6115a0f7c811b409c00f3232/html5/thumbnails/11.jpg)
• Safe and reproducible approach
• Beware of bovine arch
![Page 12: Supra-aortic trunk TAVI - CACVS · 2020. 4. 29. · May 2009 –September 2017 104 transthoracic 87 transarterial (83.9 % trans-subclavian and 16.1% transcarotid) Mortality lowered](https://reader035.fdocuments.in/reader035/viewer/2022071418/6115a0f7c811b409c00f3232/html5/thumbnails/12.jpg)
![Page 13: Supra-aortic trunk TAVI - CACVS · 2020. 4. 29. · May 2009 –September 2017 104 transthoracic 87 transarterial (83.9 % trans-subclavian and 16.1% transcarotid) Mortality lowered](https://reader035.fdocuments.in/reader035/viewer/2022071418/6115a0f7c811b409c00f3232/html5/thumbnails/13.jpg)
![Page 14: Supra-aortic trunk TAVI - CACVS · 2020. 4. 29. · May 2009 –September 2017 104 transthoracic 87 transarterial (83.9 % trans-subclavian and 16.1% transcarotid) Mortality lowered](https://reader035.fdocuments.in/reader035/viewer/2022071418/6115a0f7c811b409c00f3232/html5/thumbnails/14.jpg)
![Page 15: Supra-aortic trunk TAVI - CACVS · 2020. 4. 29. · May 2009 –September 2017 104 transthoracic 87 transarterial (83.9 % trans-subclavian and 16.1% transcarotid) Mortality lowered](https://reader035.fdocuments.in/reader035/viewer/2022071418/6115a0f7c811b409c00f3232/html5/thumbnails/15.jpg)
Conclusion
• TA non TF-TAVI are as safe as TF
• TA should be preferred to transthoracic approaches
• Results are excellent
• Trans carotid is supplanting transsubclavian