All you need to know about TAVI session a "tour de force"
A “All you need to know about TAVI” session on 19 May was declared a “tour de force” by session chair, Nicolo Piazza. The series of lectures reviewed the current state of transcatheter aortic valve implantation (TAVI) devices, techniques and data. It also looked at problems facing the procedures, and where the future might lie for TAVI technologies. Dedicated discussion sections between the lectures enabled active participants to quiz presenters and debate optimal techniques and devices, delving deeper into the world of TAVI.
The session began with a review of clinical results with established TAVI devices by N. Piazza, who said of his talk, “We realised that the results are actually improving from the foundation of the more contemporary devices.” He noted that mortality, major adverse event and stroke results were improving across the literature. However, N. Piazza explained that rates of mild postprocedural paravalvular leak and rates of pacemaker implantation remained important for certain devices.
The second talk in the session was presented by Simon Redwood, who covered technical issues surrounding TAVI procedures, including the use of adjunctive technology intended to improve outcomes. “I think the take-home message was that patient selection is extremely important, perhaps even more so than the technical aspect of the procedure,” commented N. Piazza. S. Redwood, who took participants through a TAVI procedure step by step – from patient and device selection to follow-up –stressing that “as these procedures become more routine and quicker, it is very easy to miss out on some steps.” Ensuring optimal patient selection, however, he said, “really is an art.”
Anna Sonia Petronio went on to review current society guidelines and recommendations for TAVI procedures. Discussing the impact of new clinical data, she explained the process of updating guidelines, and gave some suggestions as to what might be included in upcoming guideline reviews. N. Piazza summarised, “Perhaps the new results that we have seen more recently suggest that TAVI should be a Class 1 indication for intermediate risk patients.” A.S. Petronio emphasised the fact that, even when we review clinical evidence and evaluate current guidelines, actually changing and deciding on new guidelines “is not easy.”
The final talk was given by Darren Mylotte, who discussed the unresolved issues of new indications and valve systems in TAVI, and the future for these issues. “Darren showed us that there is still innovation coming our way in the TAVI field,” noted N. Piazza. The talk covered innovations in the development of lower profile devices, and in the accuracy of device position and delivery. D. Mylotte also reviewed the bicuspid aortic valve TAVI indication, suggesting that more study was probably required. Some current devices, however, were shown to be producing “excellent” results. Commenting on the future of TAVI procedures, Mylotte noted an increasing trend away from surgery and towards the interventional procedure. “Things at each institution are going to have to change,” he said. “Financial and strategic planning will all need to change to deal with this increased volume”.