H. Rickli - Cardiocentro Ticino

TAVI without STANDBY?
Hans Rickli, St.Gallen
Conflict of Interest to declare: No cardiac surgery
TAVI without STANDBY?
Guidelines on the management of valvular heart
disease (version 2016?
2012 )
Carrel
European Heart Journal (2012) 33, 2451–2496
I think it’s better
to stay at
home?
If you want
to know
the future,
look at the
past
On-site cardiac surgery for PCI?
1977
No PCI without on-site
surgery…..
1986
«….No cardiac surgery
needed: PCI can be done
without on-site surgery…..»
The PCI Story
CH: First-Stent – PCI without onsite cardiac surgery: 11 years
1977
First TAVI 3/2002
Cribier et al. Circulation 2002;106:3006–3008.
1986
1997: PCI without onsite cardiac surgery
allowed
TAVI without on-site cardiac
surgery: extension to all teaching
centers…..?
Percutaneous Coronary Intervention at Centers With
and Without On-Site Surgical Backup
An Updated Meta-Analysis of 23 Studies
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Clin
Circulation. 2015;132:388-401c
transcatheter aortic valve implantation (TAVI) and transcatheter mitral valve repair (TMVR) from 2006 to 2015 in Switzerland TMVR TAVI 1417
1003
781
654
501
382
257
249
127
0
0
2006
0
18
2007
0
2008
33
2009
67
2010
104
2011
122
2012
264
135
2013
2014
2015
Coronary angiographies (CA) and percutaneous coronary interventions (PCI) in all centres during the year 2015 in Switzerland Pfäffikon, Cardiance Clinic Lachen 5/2014) S pital (Lstart achen Spital Genolier Clinique Morges Hôpital Kantonsspital Baden Basel St.Claraspital Frauenfeld Kantospital Aarau Hirslanden Klinik Genève Clinique des GrangeZes Sion Clinique de la Valère Luzern Klinik St. Anna Bern Tiefenauspital Liestal Kantonsspital Baselland Lausanne Clinique de la Source Genève Hôpital de La Tour Biel Spitalzentrum Kreuzlingen Herz-­‐Neuro-­‐Zentrum Bodensee Winterthur Kantonsspital Chur Kantonsspital Zürich Klinik im Park Bern Lindenhofspital Sion Hôpital du Valais, HVS Solothurn Bürgerspital Genève Hôpitaux universitaires Lausanne Clinique Cecil Bern Klinik Beau-­‐Site Kantonsspital Aarau Fribourg Hopital Lugano Cardiocentro Ticino Herzklinik Hirslanden -­‐ Zürich Lausanne Hospitalier universitaire vaudois Luzern Kantonsspital Basel Universitätsspital St. Gallen Kantonsspital Zürich Universitätsspital Zürich Triemli Stadtspital Bern Universitätsspital 36 69 77 204 142 293 124 322 106 369 184 418 244 501 210 529 253 531 274 598 124 608 319 623 462 758 297 819 357 863 357 879 505 930 466 945 615 1103 489 1285 592 1127 591 1300 739 1314 764 1488 593 1519 507 1542 964 953 CH teaching centres
interventional
cardiology without onsite surgery
1905 1989 1289 2329 988 2364 1168 1526 1279 2393 2433 2535 1155 2583 1331 2791 1609 2469 3226 4922 Eggebrecht H. et al AQUA. Eur Heart J 2016
Unmatched: Without on-site cardiac surgery (CS-):
older, more comorbidities,
at higher predicted risks of death
Eggebrecht H. et al AQUA. Eur Heart J 2016
Eggebrecht H. et al AQUA. Eur Heart J 2016
Eggebrecht H. et al AQUA. Eur Heart J 2016
3:0
Matched pairs (CS-) vs. (CS+) no difference:
Intraprocedural complications
In-hospital death
New Pacemaker/ICD-Implantation
Eggebrecht H. et al AQUA. Eur Heart J 2016
Management of intraprocedural Complications
Repositioning /Valve in valve
Interventional /Case by case
Interventional /Case by case
1/500 pts? Why not Cardiac surgery for other Aortic dissection???
On-site heart team and prevention is the best way to treat anular rupture
and pericardial tamponade (guide wire selection)
Annular Rupture During Transcatheter
Aortic Valve Replacement
Classification, Pathophysiology,
Diagnostics,
Treatment Approaches, and Prevention
J Am Coll Cardiol Intv 2015;8:1–9
Eggebrecht H. et al AQUA. Eur Heart J 2016
Experienced team with
-  Anaesthesiologist
-  Neurologist
-  Vascular surgeon…
Guidelines on the management of valvular heart
disease (2016)
arrel
European Heart Journal (2012) 33, 2451–2496
TAVI without STANDBY?
TAVI without on-site surgery?
Yes, but…….
Definition of the on-site
conditions for TAVI:
-  Heart Team on site
-  Restriction to teaching
centers?
-  How to solve pre-defined
complications
Thank you!
[email protected]