Aortic Stenosis Treatment by Age in the United States: Evidence of Institutional Ageism

A one-hour symposia at TCT 2022 focused on the influence of age related to time to diagnosis, referral and treatment of aortic stenosis (AS) for patients 80 and above.

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1. CONSIDERATIONS OF TAVR AND SAVR BY AGE IN THE US INCLUDING A CLINICALLY RELEVANT DEFINITION OF BIOPROSTHETIC DURABILITY
2. PATTERNS OF REFERRAL TIMES AND TREATMENT TIMES FOR AS IN THE US BY AGE
3. RESULTS AND BENEFITS OF AORTIC INTERVENTION IN THE US BY AGE

 

Faculty
  • David A. Wood, MD – Vancouver General Hospital, Vancouver, BC, Canada (Moderator)
  • Evelio Rodriguez, MD – Ascension Saint Thomas , Nashville, TN
  • Sammy Elmariah, MD – University of California, San Francisco, CA
  • Megan Coylewright, MD – Erlanger Health System, Chattanooga, TN
Objectives

Recognize the influence of patient age related to diagnosis of AS, referral and time to treatment

  • Understand patients' goals for the treatment of their aortic stenosis

  • Increase awareness of the benefits and outcomes of TAVR in elderly patients

  • Review the evolution of bioprosthetic valve durability definitions and recognize the need for a more clinically relevant definition

navigating complex cases (NCC)

Explore a case-based webinar series on current decision drivers for the lifetime management of patients with heart valve disease. CME credits are not offered for this educational program.

THV-IN-THV | AORTIC VALVE-IN-VALVE | TAVR IN BICUSPID VALVES

 

NCC: THV-IN-THV

Vinod Thourani, MD, of Piedmont Healthcare and Marcus Heart and Vascular Center, Atlanta, GA, moderates a case-based webinar on THV-in-THV and understanding its importance in lifetime management of aortic stenosis.

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Faculty
  • Vinod Thourani, MD, CTS – Marcus Heart and Vascular Center – Piedmont Healthcare, Atlanta, GA
  • Robert Cubeddu, MD, IC – NCH Heart Institute – NCH Healthcare, Naples, FL
  • Pranav Loyalka, MD, IC – HCA Gulf Coast – HCA Houston Medical Center, Houston, TX
  • Janar Sathananthan, MD, IC – St. Paul’s Hospital – Centre for Heart Valve Innovation, Vancouver, BC
Objectives
  • Recognize when THV explant is indicated, review current clinical experience and recommended best surgical practice
  • Review current data associated with THV-in-THV and bench data to support best practices
  • Review and discuss THV-in-THV case examples of early and late bioprosthetic valve dysfunction 

NCC: AORTIC VALVE-IN-VALVE

Yoshi Kaneko, MD, of Brigham and Women’s Hospital, Boston, MA, moderates a case-based webinar on Aortic Valve-in-Valve (ViV).

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Faculty
  • Tsuyoshi Kaneko, MD, CTS – Brigham and Women’s Hospital, Boston, MA
  • Karim Al-Azizi, IC – Baylor Scott & White Hospital, Plano, TX
  • Stephen Bailey, CTS – Allegheny General Hospital, Pittsburgh, PA
  • Jeremiah Depta, IC – Rochester General Hospital, Rochester, NY
Objectives
  • Convey experience and techniques to optimize procedural and clinical outcomes with SAPIEN 3 and SAPIEN 3 Ultra in Aortic ViV
  • Appreciate mechanism of discordance between Echo derived gradient and true Cath pressure gradient
  • Discuss impact of post TAVR-ViV echo hemodynamic parameters on clinical outcomes
  • Illustrate best clinical practices with SAPIEN 3 and SAPIEN 3 Ultra case examples

 

NCC: TAVR IN BICUSPID VALVES

Michael Rinaldi, MD, of Atrium Health, Charlotte, NC, moderates a case-based webinar on TAVR in bicuspid valves.

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Faculty
  • Michael Rinaldi, MD, IC – Atrium Health Carolinas Medical Center, Charlotte, NC
  • Hasan Jilaihawi, MD, IC – NYU Langone, New York, NY
  • Amar Krishnaswamy, MD, IC – Cleveland Clinic, Cleveland, OH
  • Eric Skipper, MD, CTS – Atrium Health Carolinas Medical Center, Charlotte, NC
  • Firas Zahr, MD, IC – Oregon Health & Science University, Portland, OR
Objectives
  • Differentiate between complex and straight forward bicuspid valves
  • Appreciate importance of CT assessment for TAVR in bicuspid valves
  • Discuss potential impact of aortopathy on outcomes
  • Review clinical experience with case examples 

TAVR HEMODYNAMICS: BEYOND THE ECHOCARDIOGRAPHIC GRADIENT

Join Martyn Thomas, MD, as he leads an in-depth discussion on the challenges and best practices of post-TAVR gradients. CME credits are not offered for this educational program. 

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Faculty
  • Martyn Thomas, MD – Edwards Lifesciences (Moderator)
  • Amr Abbas, MD, IC – Beaumont Hospital, Royal Oak, MI
  • David Wood, MD, IC – Vancouver General Hospital, Vancouver, BC
Objectives
  • Share history and experience related to hemodynamics post-TAVR
  • Facilitate understanding of both echo and catheter derived gradients post-TAVR
  • Demonstrate dual pigtail technique for catheter derived gradient

 OPTIMAL TAVR PATHWAY AND TECHNIQUES: CAN WE REACH A CONSENSUS BASED ON A WIDE-RANGING U.S. SURVEY?

Join Dr. Martin Leon as he moderates a lively discussion on the outcomes of this nationwide survey. Dr. Aidan Raney and Dr. Joseph Walsh share the survey results, while panelists offer their insights and experiences. CME credits are not offered for this educational program. 

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1. INTRODUCTION AND BACKGROUND

Dr. Leon opens the Edwards sponsored session at TCT 2021. Presenters share statistics on survey participants’ lifetime TAVR procedure volumes and annual hospital case volumes. 

2. PROCEDURAL PLANNING AND VALVE SIZING

Results and discussion on who reviews CT data for the purpose of procedural planning and valve sizing, as well as discussion on who is administering anesthesia for routine cases.

3. INTRA-PROCEDURAL DECISION MAKING

Review and discussion on the type of anesthesia used and who is administering it, pigtail catheter access and transitioning from femoral to radial, use of and data related to CEP, best practices for ultrasound guided access, and current practices for hemostasis.

4. VALVE DEVELOPMENT

Discussion on various techniques for successful valve deployment. 

5. ASSESSMENT OF PVL AND HEPARIN REVERSAL

Discussion on using echo to assess PVL and heparin dosing, safety and efficacy of using Protamine.

6. POST-PROCEDURAL DECISION MAKING

Discussion on same day discharge, DOAC + SAPT versus DOAC, temporary pacing, pacemaker implants and mobile cardiac outpatient telemetry.

 

Faculty
  • Martin B. Leon, MD – Columbia University Medical Center, New York, NY  
  • Aidan Raney, MD – St. Joseph’s Hospital, Orange, CA
  • Joseph Walsh, MD – St. Alphonsus Medical Center, Boise, ID
  • Amar Krishsnaswamy, MD – Cleveland Clinic, Cleveland, OH
  • Tamim Nazif, MD – Columbia University Medical Center, New York, NY
  • Christian Spies, MD – Sutter Health, San Francisco, CA
  • Molly Szerlip, MD – Baylor Scott and White, Plano, TX
Objectives
  • Review and discuss results of a nationwide survey designed to characterize TAVR procedure-related clinical practice variability across programs with different case volumes
  • Gain knowledge from nationally recognized panelists of their practice patterns and procedural steps
  • Discuss opportunities for standardizing TAVR procedure steps supported with clinical/scientific evidence