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Adult ECMO Specialist Course — Didactic
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Dr. Prakash Balan lectures and discusses the latest outcomes data on TransCatheter Valve Replacement (TAVR) Vs. Surgical Aortic Valve Replacement (SAVR)
The landscape of aortic valve replacement has undergone significant transformation with the advent of Transcatheter Aortic Valve Replacement (TAVR), especially for patients across various surgical risk categories. This video provides an in-depth analysis of the outcomes and technological advancements in TAVR compared to traditional Surgical Aortic Valve Replacement (SAVR), offering critical insights for perfusionists engaged in these procedures.
The session begins with a historical overview of TAVR's development over the past decade, describing it as a maturation of transformational technology initially focused on patients ineligible for surgery. The evolution of TAVR is highlighted through a series of clinical trials, demonstrating its efficacy and safety, which now positions it as a less invasive alternative to SAVR, even for patients with lower surgical risk.
The video outlines six significant clinical trials that have progressively demonstrated TAVR’s applicability to broader patient groups—from high-risk to low-risk individuals. These trials include the PARTNER trials and the CoreValve trials, each contributing to the robust evidence supporting the use of TAVR in different risk stratifications.
Significant advancements in TAVR device technology are discussed, emphasizing the enhancements from earlier designs like the SAPIEN valve to newer iterations such as the SAPIEN 3 and various CoreValve models. These improvements have not only reduced procedural risks but also enhanced patient outcomes by minimizing complications such as paravalvular leakage.
The presentation delves into the shift from high to low surgical risk patient groups, detailing how TAVR has become a viable option across the board. It discusses the criteria used in trials, such as the STS score, and how these criteria determine patient eligibility and expected outcomes in both TAVR and SAVR procedures.
A comprehensive comparison of recent trial results, including the PARTNER 3 trial and the CoreValve Low-Risk trial, is provided. These trials have shown that TAVR not only competes with but in many cases, surpasses SAVR in terms of efficacy, with lower rates of disabling strokes and re-hospitalizations, marking a significant shift in treatment paradigms.
The video concludes with a forward-looking perspective on the implications of these findings for clinical practice. It discusses ongoing research and potential future innovations in valve technology and procedural techniques. The role of the heart team, including perfusionists, in deciding the optimal intervention for each patient is emphasized, ensuring a personalized approach to aortic valve replacement.
This presentation is an invaluable resource for perfusionists and other cardiac care professionals, providing them with a detailed understanding of the current state and future potential of aortic valve replacement therapies. It underscores the importance of staying updated with technological and clinical developments to enhance patient care and outcomes in cardiac surgery settings.
Dr. Prakash Balan is a board certified Physician and Assistant Professor for the Department of Internal Medicine at McGovern Medical School at The University of Texas Health Science Center
