A new era in TAVI: key recommendations from the 2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease
17 Oct 2017 - From PCR LONDON VALVES 2017
Bernard Prendergast, UK, shares key recommendations from the 2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease, amongst them the continued endorsement of the practice of the Heart Team, new international randomised controlled trials demonstrating the effectiveness of TAVI in intermediate-risk patients, and long-term follow-up of these patients to be shared by all members of the Heart Team.
TAVI is now a mature technology that will become the dominant treatment for aortic stenosis in the very near future, and will require a change in the patient referral pathway from cardiac surgeon to cardiologist. It will also pose a challenge: as the number of patients eligible for TAVI is set to triple to quadruple within the next 5 years, programmes already saturated in many centres will be under pressure, and extended training will be needed for the next generation of interventional cardiologists.
Learnings from the SAVI-TF registry and the MORENA comparative analysis
16 Oct 2017 - From PCR LONDON VALVES 2017
Won-Keun KIM, Germany, discusses two studies on devices that can be used in all patients that physicians encounter. The SAVI-TF registry is a post-market registry performed after CE-mark in order to look at the safety and efficacy of the self-expanding ACURATE-neo™ transcathether valve. An all-comers registry displaying real life procedures, it looked at a contemporary TAVI population of 1,000 patients. Outcome data were excellent: outstanding 30-day mortality of 1.4% and moderate to severe PV leaks at around 4%.
The MORENA study is a multicenter propensity-matched comparison of two novel transfemoral transcathether heart valves : ACURATE neo™ vs SAPIEN™ 3, considered as the standard for TAVI treatment today. A retrospective analysis was performed in 3 centres in German. Procedure outcomes showed no difference between the two devices, except for some minor differences regarding PVL where the SAPIEN™3 performed slightly better, but the ACURATE-neo™ had some other advantages with pacemaker rate and post-procedure gradients.
Perspectives from the REPRISE III randomised trial
16 Oct 2017 - From PCR LONDON VALVES 2017
Lars Sondergaard, Denmark talks about the REPRISE III trial, presented at EuroPCR 2017. A prospective, randomised investigation of a novel transcathether aortic valve implantation system, the trial compares the Lotus valve and the CoreValve, with findings that show the far better performance of the Lotus valve in minimising paravalvular leak (PVL).
As the only mechanical expandable valve with an adaptive sealing, the Lotus valve allows for result assessment before the valve is deployed, letting the physician reposition it as needed, which makes it unique on the market.
Atherectomy for calcified coronary plaques
26 Sep 2017 - From EUROPCR 2017
What is the management strategy for heavily calcified coronary stenosis? E. Barbato, F. Mangiacapra and J. Daemen offer you their expert view. How difficult is it to recognize a heavily calcified lesion? Is angiography enough? Learn why IVUS or OCT can give us a broader idea of the vessel anatomy, including identifying calcific nodules. Be confident, by using a procedure you know well; be prepared, to recognize calcification and complications. Will a rotoblator be necessary? What burr size would you use? Remember, it is not just about getting the stent across…it’s about optimal expansion. More tips and tricks? Start here…
Cardiac regenerative strategies for interventionalist
15 Sep 2017 - From EUROPCR 2017
Can we create new myocardia and develop a “cure” for heart failure? Faced with an array of medical and device treatment, G.G Toth, D. Burkhoff and W. Wojakowski underline what is missing in current strategies apart from heart transplants – Do they actually have an effect on the missing or remodeled myocytes? How could interventionalists replace muscle cells that have been destroyed or altered? Current and past cell therapies are reviewed along with emerging data, types of cells tested as well as looking at delivery techniques or specific patient groups. Critical problems and limitations facing research are discussed to understand why advancing this therapy has been unsuccessful. Learn more…
2017 ESC Silver medalist and Andreas Grüntzig lecturer, MC Morice, speaks with 2017 ESC Gold medalist, William Wijns
40 years of angioplasty, 15 years of TAVI! Join MC Morice, this year’s Andreas Grüntzig lecturer and recipient of the 2017 ESC Silver Medal, in this conversation with W. Wijns, the ESC 2017 Gold medal awardee, as these two pioneers discuss their lifework. MC Morice looks at her ongoing commitment to research including her ground-breaking 1995 study on intracoronary stenting without Coumadin. W.Wijns, remembering the patient at the centre of our discipline, sees Stent for Life – with its positive effect on patient access to therapies and significant impact on morbidity and mortality – along with the educational activities of the PCR family, as part of his living legacy.
Renal denervation and uncontrolled hypertension – evolving data
06 Sep 2017
Can renal denervation have a positive effect on controlling blood pressure? F. Mahfoud reports from the ESC Congress 2017 in Barcelona as he introduces a late breaking trial which answers in the affirmative. Three-month results of the international SPYRAL HTN-OFF MED study demonstrated a “significant reduction in ambulatory and office blood pressure” in the denervation arm. Learning from earlier trials, discover how this new study could provide sound biological proof of principal, underlining the evolution in our understanding of anatomy and particularly in our approach to the technique itself. What does the future hold? What type of patient responds best? Find out more here…
How intravascular imaging can optimise PCI results
21 Aug 2017 - From EUROPCR 2017
Complex PCI, STEMI...does using IVUS really reduce major adverse cardiovascular events? Join C. Cook, Z. Ali and G. Guagliumi as they review the proper way to use this “irrefutable” imaging tool. Does IVUS have a role throughout a procedure? How should you prepare and map your strategy in advance? Leanr why they characterise this as “the essence of decision–making”? What does the future hold in store for these technologies? How can we move to more “objective” measurements? What is the importance of the upcoming trial comparing high-risk patients and high-risk lesion randomised to angiography against OCT? Learn more here…
Bifurcation stenting, when do I need two stents?
18 Aug 2017 - From EUROPCR 2017
Treating bifurcation lesions is a challenge, and the need to convert to a two-stent strategies can be daunting. Join experts G. G. Toth, T. Johnson and F. Mangiacapra as they discuss their own insights and suggestions, reminding us to never forget the provisional approach. What percentage of cases might necessitate converting to a two-stent technique? What elements in anatomy, lesion or the type of patient might require this change? Which two-stent strategy should you begin with – and practice? What imaging tools are useful and what possible role does functional assessment play? Watch video and find out…
PCRonline Journal Club
Looking for the online address where you can find reviews of the latest articles of interest chosen by your peers – articles that can have an impact on your practice today? PCRonline is dedicated to being your first-stop in knowing what’s going on in the world of interventional cardiology, in Europe and internationally! D. Milasinovic introduces us to the online community where you are not only invited to read an article, but comment as well! Join us!