TAVR or SAVR: Beyond the STS Score

5/24/2017

TAVR or SAVR: Beyond the STS Score

Juan Crestanello, MD

Lakshmi Prasad Dasi, PhD

Division of Cardiac Surgery Department of Biomedical Engineering

The Ohio State University Wexner Medical Center

1

Disclosures

Dr. Dasi NIH/NHLBI NIH/NIBIB NIH/NCAI AHA

Dr. Crestanello Research Grants from:

Medtronic Boston Scientific Abbot Vascular

2

1

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Patient Selection for SAVR vs TAVR

Risk Profile STS PROM + Frailty + Other Comorbidities

Low Risk

Intermediate Risk

High Risk

Extreme Innoperable

Risk

SAVR

TAVR

Moving Beyond Risk

Age-Life Expectancy-Valve Durability Concomitant cardiac disease

Mitral valve disease Coronary artery disease Valve and Aortic Root Anatomy Bicuspid Aortic Valve LVOT Calcification Small root-low lying coronary ostia

2

Moving Beyond Risk

Age-Life Expectancy-Valve Durability Concomitant cardiac disease

Mitral valve disease Coronary artery disease Valve and Aortic Root Anatomy Bicuspid Aortic Valve LVOT Calcification Small root-low lying coronary ostia

5/24/2017

Age and Life Expectancy: Longer Survival

Survival General Population

40

32

30 24

20

17

10

8

Survival after Surgical AVR

40

30

21

20 15

11

10

6

Survival (Years) Survival (Years)

0 50 60 70 80 Age

0 50 60 70 80 Age

Social Security Life Tables

6

Birkmeyer et al. Ann Thorac Surg 2000

3

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Surgical Valve Durability

Freedom from Structural Valve Deterioration: Surgical AVR

10-15 years

Bourguinion et al. Ann Thorac Surg 2015

7

Age and Life Expectancy: Longer Survival

Survival General Population

40

32

30 24

20

17

10

8

Survival after Surgical AVR

40

30

21

20 15

11

10

6

Survival (Years) Survival (Years)

0

0

50 60 70 80

50 60 70 80

FArgeeedom From SVD: Surgical AVARge

Social Security Life Tables

8

Birkmeyer et al. Ann Thorac Surg 2000

4

5/24/2017

Age and Life Expectancy: Longer Survival

Survival General Population

40

32

30 24

20

17

10

8

Survival after Surgical AVR

40

32% 21% 12% 3%

30

21

20

REO1P5ERATION

11

10

6

Survival (Years) Survival (Years)

0

0

50 60 70 80

50 60 70 80

FArgeeedom From SVD: Surgical AVARge

Social Security Life Tables

9

Birkmeyer et al. Ann Thorac Surg 2000

TAVR Durability

10

5

TAVR Durability

5/24/2017

11

Age and Life Expectancy: Longer Survival

Survival General Population

40

32

30 24

20

17

10

8

Survival

after Surgical AVR

40

HIGHER

REOPERATION

30

RATE

21

20 15

11

10

6

Survival (Years) Survival (Years)

0

0

50 60 70 80

50 60 70 80

Age Freedom From SVD: TAVR Age

12

6

Moving Beyond Risk

Age-Life Expectancy-Valve Durability Concomitant cardiac disease

Mitral valve disease Coronary artery disease Ascending aortic aneurysms Other Valve and Aortic Root Anatomy LVOT Calcification Small root-low lying coronary ostia Bicuspid Aortic Valve

Moving Beyond Risk

Age-Life Expectancy-Valve Durability Concomitant cardiac disease

Mitral valve disease Coronary artery disease Ascending aortic aneurysms Other Valve and Aortic Root Anatomy Annular and LVOT Calcification Small root-low lying coronary ostia Bicuspid Aortic Valve

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Annular and LVOT Calcification

LVOT Calcification

Valve Underexpansion

Paravalvular Leak

15

Annular Rupture

Annular and LVOT Calcification

Paravalvular Leak - opposing side

16

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