JIM 2020: Innovations in TAVI — Dr Oscar Mendiz

Dr Oscar A Mendiz (Favaloro Foundation, Buenos Aires, AR) discusses innovations in transcatheter aortic valve replacement (TAVI) at JIM 2020.
 
Questions:
1. Can you describe your case presented at JIM 2020?
2. How does this showcase innovation in TAVI in 2020?
3. What do you consider the greatest innovations in TAVI to date?
4. For which patients do you now recommend TAVI?
5. Should TAVI be the default treatment for patients with symptomatic AS over surgery?
6. What unmet needs still exist in TAVI? Are there innovations on the horizon to solve these?
 
Filmed on location at the JIM 2020.
 
Interviewer: Ashlynne Merrifield
Videographer: Dom Woodruff
 

Transcript Below :

Questio 1 : Can you describe your case presented at JIM 2020?

Today I present a case of overlapping technique It means the deployment of the Evolut R CoreValve in a patients that we tried to put in a position different than we have been using lately. So with this position, we have a better alignment and we do believe that we can decrease the pacemaker implantation rate. 

Question 2 : How does this showcase innovation in TAVI in 2020?

This innovation is not an innovation in itself. We are modifying the technique that we have been using for the past, probably, 10 years. But with this new technique, we are decreasing the pacemaker rate. In a survey that we did in Latin America with low-volume centers, we have done 240 cases, and the pacemaker implantation rate was below double digits, it means 4%. 

Question 3 : What do you consider the greatest innovations in TAVI to date?

I think the greatest innovation in TAVI today are different devices. We can select each device for different patients and different anatomic situations. I do believe with the evolution of the new devices with a very low profile now, we have better closure devices also and we are decreasing the complication rate. The procedure is almost a PCI-like procedure with conscious sedation. So I think with this evolution we can offer this new technology to many other patients. 

Question 4 : For which patients do you now recommend TAVI?

TAVI recommendations, according to the guidelines, can be done for the non-surgical candidate. Also for high-risk patients but now with the new evidence, we can also offer TAVR/TAVI for patients with intermediate or low-risk. Unfortunately, I live in Latin America, or fortunately, because in Latin America the economic situation cannot allow us to offer TAVI for low-risk patients. So we are only doing high or very high-risk patients. But I think in the near future, TAVR is going to be the default technology for patients with aortic stenosis. 

Question 5 : Should TAVI be the default treatment for patients with symptomatic AS over surgery?

For sure, TAVI is going to be the default technology. We have to consider that there is not a single paper saying that surgery is better than TAVR. And so for the next years, I think technology will become- I mean, the default technology for all patients with aortic stenosis and suitable anatomy. Probably, we have to research a little bit more about different situations like aortic regurgitation or patients with bicuspid valves. 

Question 6 : What unmet needs still exist in TAVI? Are there innovations on the horizon to solve these?

I think the unmet needs regarding TAVI refers to different anatomic situations as I have already mentioned, patient with bicuspid valves, and also probably, we have to prove a little bit more about the durability. I mean, the first two limitations to not offer TAVR to everybody are, in my opinion, only two. First, will going to be economic because it's still more expensive than surgery. This is going to be very easily solved in the near future. And the second is durability, especially if you are thinking in low-risk patients. Especially for those who are younger, I mean, younger than 70 years old. For these patients, I think I need a little bit more follow-up to offer to everybody.