This post was authored by Xiushui (Mike) Ren, MD, affiliate member of the ACC, reporting live for CardioSource.org.

The Transcatheter Valve Therapeutics (TVT) 2013 conference kicked-off yesterday with “The Annual Mad Dash” presentation by Martin Leon, MD, FACC, who summarized the past year of transcatheter aortic valve replacement (TAVR) research in an impressive 20 minutes. According to Leon, there were a total of 835 TAVR manuscripts published in 2012 and 2013. Highlights included:

• A study by Dr. Vergnat, et al., using 3-D transesophageal echocardiography showing that TAVR resulted in better preserved mitral annular geometry as compared to surgical aortic valve replacement (AVR)
• Publication of TAVR guidelines by the European Society of Cardiology/ European Association for Cardio-Thoracic Surgery, which gave a Class I recommendation for a Heart Team, availability of on-site cardiac surgery, and for inoperable surgical AVR status; and class IIa indication for high-risk operable surgical AVR status
• Formulation of the second generation Valve Academic Research Consortium (VARC-2) definitions
• Implementation of the echocardiography core laboratory
• Completion of patient enrollment for the Medtronic CoreValve pivotal trial (both extreme and high-risk patients)
• German Aortic Valve Registry updates of 13,860 surgical AVR and TAVR patients
• Increase in TAVR volume in the US in 2013, including approximately 8000 commercial TAVR procedures through quarter 1 of 2013 and 308 TAVR procedures at Columbia University Hospital in 2012
• Update on the STS/ACC TVT Registry
• Growth of TAVR in 2013, with U.S. market estimates of $376 million in 2013, $534 million in 2014, and $858 million 2016.
• Studies by Dr. Fairbairn et al. and by Dr. Osnabrugge et al. showing that TAVR while cost-effective for high-risk patients, may not be cost-effective in intermediate-risk patients
• Initial data by Dr. Sergie et al. showing lower bleeding risk with bivalirudin as compared to unfractionated heparin in TAVR procedures
• Possible 1-day hospital discharge in selected TAVR patients based on preliminary data from Dr. Wood et al.
• Confirmatory studies showing survival advantage in females with TAVR as compared to surgical AVR
• Studies showing decreased patent-prosthesis mismatch with TAVR as compared to surgical AVR
• Predictors of mortality in TAVR patients with low-flow severe aortic stenosis
• Procedural advantages of Sapien XT system compared to the Edwards Sapien system
• Study by Dr. Nombela-Franco et al. comparing Edwards Sapien valve and Medtronic CoreValve showing better gradient profile with Medtronic CoreValve but with more paravalvular leak
• Case reports of alcohol septal ablation for “suicide left ventricle” after TAVR
• Case reports of early and late TAVR valve thrombosis
• Predictors of aortic annular rupture in balloon-expandable TAVR
• Meta-analysis of predictors and outcomes of aortic regurgitation after TAVR by Dr. Athappan (predictors include implantation depth, valve undersizing, and calcium score)

Dr. Leon concluded his session with optimism about the future of TAVR. Several new transcatheter valves are in the pipeline, including Direct Flow, Sadra Lotus, St. Jude Portico, Engager, Symetis Scurate, and Jena Valve, and Edwards Sapien 3. In addition, transcutaneous ventricular access and closure systems and cerebral embolic protection devices will become available. Finally, indications for TAVR may expand with results of studies such as using TAVR in pure native valve aortic regurgitation.

For more TAVR information, visit the TVT Resource Center. For more on the conference, click here.

< Back to Listings