Techniques in Transapical AVR

Vinod H. Thourani, MD

Professor of Surgery and MedicineChief of Cardiothoracic Surgery, Emory Hospital Midtown

Co-Director: Structural Heart and Valve Center

Emory University School of Medicine

AATSApril 2015

Disclosures• Edwards Lifesciences

– Emory Co-PI: PARTNER 1 and 2– National Co-PI: PARTNER 2 (SAPIEN 3 Trial) with Dr. Susheel Kodali

• St. Jude Medical– Emory PI Portico Trial, Structural Heart Advisory board

• Boston Scientific – Emory PI: REPRISE Trial– Advisory Board, Executive Comm (Lotus Valve Trial)

• Medtronic– Emory PI: SURTAVI Trial

• Jenavalve– National Co-PI with Dr. Martin Leon

• Abbott Medical– Emory Co-PI: Coapt Trial

• Apica Cardiovascular– IP, co-founder

In 2015

Transapical and Transaortic Transcatheter Aortic Valve

Replacement in the United States

Thourani, Jensen, Babaliaros, Suri, Vemulapalli, Dai, Brennan, Rumsfeld, Edwards, Tuzcu, Svensson, Szeto, Herrmann, Kirtane,

Kodali, Cohen, Lerakis, Devireddy, Sarin, Carroll, Holmes, Grover, Williams, Maniar, Shahian, and Mack

On behalf of the ACC/STS TVT Database Team

51st Annual Meeting of the STS

January 26, 2015

Access Site

Source: STS/ACC TVT Registry (7/1/2012-6/30/2014 )

0 3 6 9 120%

10%

20%

30%

40%

Overall TA TAo

Months from Index Procedure

Mo

rta

lity

Mortality OverallN=4,953

TA TAVR(N=4,085)

TAo TAVR(N=868)

P value

30 Day (%) 9.1 8.8 10.3 0.006

6 Month (%) 20.3 19.7 22.8

1 Year (%) 26.3 25.6 30.3

n Single-lumen intubationn TEEn Foley catheter, translucent defib padsn Small roll parallel to spine behind L scapulan 5-6 cm 5th - 6th intercostal anterolateral

thoracotomyn 6F access to femoral artn Pacing wire via femoral veinn Lidocaine 100mgn Heparin > ACT 250 seconds

Transapical Technique

Transapical Technique

Transapical Technique

n Transapical AVR is:n Direct and antegraden Potential for minimal embolic neurologic eventsn No limitation to sheath diametern Expeditious and less time consuming

n Minimizing radiationn Minimizing contrast to the elderly patient

n Applicable in all patients

Summary

Need for TA Access in the FutureThe TMVR is Coming

n It allows minimal morbidity and mortality when careful and thoughtful surgical technique is followed

n Success can only be achieved with a collaborative and dedicated team

Conclusions

Thank You

Vinod H. Thourani, MD

vthoura@emory.edu