Monday, April 04, 2011


The Annual Scientific meeting of ACC started in New Orleans on Sunday, 3rd April and will go on till weds 6 th April. On day one, probably the most exciting presentation was on Partner Cohort A 1 year results, which many of us have been waiting. You may remember that the Partner trial was to compare Transfemoral Aortic Valve implantation ( TAVI ), using the first generation Sapien ( Edwards lab ) TAVI for the treatment of severe aortic stenosis in patients who were deemed either high risk for surgery or in-eligible for surgery. Cohort B ( whose results were presented in last years TCT ) was a comparison of TAVI versus standard medical therapy in patients who were deemed in-eligible for surgery, and cohort A was a non-inferiority comparison of TAVI against surgery in patients at high risk for surgery.
The Partners Cohort B results presented at TCT last year shows that TAVI reduced all cause mortality by 46% and cardiovascular mortality by 61%. TAVI ( cost not an issue ) is clearly a good alternative in patients with severe Aortic Stenosis, in patients not eligible for surgery.
The Partners Cohort A results was presented in the on-going ACC annual scientific meeting at New Orleans. Principal investigator is Dr Craig Smith. He presented the results for the 699 patients in Co0hort A who were seen in 26 centers across the US, 3 in Canada, and one in Germany. They were comparing the use of TAVI against conventional surgery of aortic valve replacement in patients who were deemed to be at high risk for surgery. The mean age was 84 years. At 30 days and at 1 year followup, the TAVI group and the conventional AVR group were equivalent in terms of all cause mortality. There was however a slightly higher incidence of strokes in the TAVI group at 30 days, and even at 1 year. Basically, TAVI was non-inferior to AVR ( aortic valve replacement ). Considering that this is the bulky first generation Sapien device, implantated by interventionist who were just learning to implant, compared with AVR by cardiac surgeons who were well trained in AVR, the results is actually quite good. Of course over time, the results should get better as second and third and fourth generation devices are in the offing. They will surely be smaller and even easier to implant.
Of course, we can also expect that in the future, the indications for TAVI will become more and more relaxed, as the devices do better and better. It is anyone's guess as to whether it will eventually replace cardiac surgical valve replacement.
Also remembering that interventionist are also working on the mitraClip procedure to repair mitral incompetence, the future does look somewhat gloomy for cardiac surgeons. maybe we should ask the cardiac surgeons to re-train as interventionist.
Anyway, I have included a presentation on TAVI in the coming " Weekend Seminar in Cardiology for GPs 2011" from the 9-10th April 2011 at the Sime Darby Covention Center.
Have you registered.

9-10th April 2011, Sime Darby Convention Center
To register, contact Jeffrey Chung : 012 6186060.
Attendance is free - it is fully sponsored.

See you there.

1 comment:

kelvin said...

wow it will lead to the development over the conferences ....thank you....