1 of 16

Surgical Considerations for Transcatheter Heart Valves��PHSL 5510

Matthew Soule, MD

Associate Professor, Cardiothoracic Surgery

2 of 16

  • Consultant for Vascudyne, Inc

​

  • No disclosure relevant to this topic

​

  • Growing field of transcatheter options

​

  • Focus of today’s discussion on aortic valve therapies

3 of 16

Objectives

1. Review clinical need for therapeutic innovation

​

2. Consider the patient/device interface

​

3. Review device iterations/improvements

​

4. Future considerations

​

​

4 of 16

Aortic Stenosis

  • Present in ~7% of population over age 65

- 55 million over 65 in US in 2019

​

  • Severe aortic stenosis in ~3% of population over age 75

​

  • Despite decades of advancement in techniques and devices, up to 1/3 of severe AS patients with symptoms not being referred for surgery (EJCS 2006)

​

  • Deemed too old, frail, comorbidities, high risk, etc

​

​

5 of 16

6 of 16

Patient/device interface

  • Vascular access

​

  • Self expanding vs balloon expandable

​

  • Conduction system, coronary access, annular apposition, aortic interaction

​

  • Retained native valve

​

7 of 16

8 of 16

9 of 16

10 of 16

11 of 16

Device iterations/improvements

  • Implant techniques

​

  • Smaller sheaths
  • Skirts
  • Open cell designs
  • Tissue technology

12 of 16

Smaller sheaths, more femoral access, decreasing CVA, less PVL, improving PPM

13 of 16

14 of 16

15 of 16

Future considerations

  • Smaller access?? Possible?

​

  • PVL and sealing

​

  • Radial force and conduction

​

  • Durability

​

  • Explantation

16 of 16

Questions?