CME ACCREDITATION AND DESIGNATION
The Cardiovascular Research Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The Cardiovascular Research Foundation designates this activity for a maximum of 0.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Documentation of awarded credit is provided for participants in exchange for completed activity evaluations.
OVERVIEW
During this webcast, there will be a comprehensive discussion on five separate topics involving TAVR and the benefits to patients.
The Partner II: Valve in Valve TAVR for patients with failing bioprosthetic will include the use of the Sapien XT Transcatheter heart valve (THV) and patients’ outcome in one year. Patients included in this study had severe stenosis, were high risk for reoperation and would be suitable for a 23mm or 26mm Sapien XT THV. Patients requiring a valve size less than 21mm or had the valve in another position were excluded from the data. A population of 197 patients with the primary endpoint of 1year mortality was reviewed. The data obtained will be reviewed and shared during this presentation. The conclusions include freedom from death, stroke or other major adverse events, positive clinical benefits and proved to be a beneficial therapeutic alternative to reoperation in patients with failed aortic bioprosthesis.
The Sapien 3: Evaluation of a Balloon-Expandable Transcatheter Aortic valve in High risk and Inoperable patients with aortic stenosis reviews the 30 day outcomes and one year outcomes of patients. Both groups showed low rates of adverse events. The inclusion criteria for high risk patients was a STS score >8 and/or the heart teams determination, the inoperative group included those with a risk of death or morbidity of >50% or patients with severe aortic stenosis. After comprehensive review of the data, patients had an improved one year survival and a low 30 day rate of complications. Also, patients had a hemodynamic and early symptomatic improvement at one year. Therefore, a conclusion can be made that TAVR is the preferred therapy for high risk and inoperable patients with aortic stenosis.
Concerns with major bleeding following TAVR prompted the Bravo 3 and questions the use of bivalirudin as an alternative to heparin. Historically heparin had been the anticoagulant of choice because of the ability to reverse it with protamine. This study is based on expert consensus and not evidence from a randomized trial. Bivalirudin has a half-life of 25 minutes and has shown reduced bleeding in patients undergoing PCI. A discussion by experts will include the dosing and use of heparin and bivalirudin during TAVR. The inclusion criteria and exclusion criteria of patients in this study will be thoroughly discussed. Overall conclusion bivalirudin did not reduce major bleeding at 48 hours post TAVR or net cardiac events at 30 days. Therefore, either heparin or bivalirudin is an option for these patients.
The other two informative discussions will include the use of 4D CT and the cardiac function of patients undergoing valve replacements. Using warfarin to decrease thrombosis in these patients via limited registry data will be discussed. The outcomes seen during 4D CT and TEE of patients receiving warfarin and reduced aortic-valve leaflet motion. The Corevalve will also support the studies and the discussions during the webcast for patients requiring valve in valve surgery. During the webcast upcoming trials and data will help the viewer with changes and improvements of TAVR in the future.
LEARNING OBJECTIVES
By the end of this program, participants should be able to:
1) Understand the population of patients that would benefit from TAVR procedures and the use of the Sapien valves.
2) Identify the outcomes of patients that are at high risk for reoperation..
3) Describe the benefits and risks of patients receiving bivalirudin or heparin during TAVR procedure and the doses of each medication.
4) Review the newest and latest information on TAVR and the implications for the future use of this procedure.
TARGET AUDIENCE
This activity is designed for interventional cardiologists, cardiac surgeons, clinical cardiologists, vascular medicine specialists, and other healthcare professionals.
ACTIVITY EVALUATION
Evaluation by questionnaire will address content, presentation, possible bias, and future educational needs.
DISCLOSURE STATEMENT
It is the policy of the Cardiovascular Research Foundation to ensure balance, independence, objectivity, and scientific rigor in all of its sponsored educational activities. Commercial support from industry does not influence educational content, faculty selection, and/or faculty presentations, and, therefore, does not compromise the scientific integrity of the educational activity.
Discussion of off-label product usage and/or off-label product use is made at the sole discretion of the faculty. Off-label product discussion and usage is not endorsed by the Cardiovascular Research Foundation or the conference directors of this activity.
Faculty participating in continuing medical education activities sponsored by the Cardiovascular Research Foundation are required to disclose to the activity audience any real or apparent conflicts of interest related to the content of their presentations. Faculty not complying with this policy are not permitted to participate in this activity.
FACULTY DISCLOSURE SUMMARY
KEY: (G/R) Grant Support/Research Contract (C/H/S) Consultant Fee/Honoraria/Speaker’s Bureau (E) Equity (R/I) Royalty/Intellectual Property Rights (S) Salary/Salary Support (O) Other Financial Benefit
Susheel Kodali: (G/R) Edwards Lifesciences, Medtronic, (C/H/S) St. Jude Medical, (E) Thubrikar Aortic Valve, Inc., (G/R) (C/H/S) Claret Medical
Vinod Thourani: (G/R) Boston Scientific, (G/R) (C/H/S) Abbott Vascular, Edwards Lifesciences, St. Jude Medical, Medtronic
Mathew Williams: (G/R) Direct Flow, (C/H/S) Abbott Vascular, (G/R) (C/H/S) Edwards Lifesciences, Medtronic
Planning Committee
Arielle Gelardi (Planner)
(S) Cardiovascular Research Foundation
ACTIVITY SPONSORSHIP AND SUPPORT
This program is sponsored by the Cardiovascular Research Foundation. It is supported through an educational grant from Edwards LifeSciences and was developed without influence from commercial supporters.
HOW TO RECEIVE CME CREDIT
To obtain CME credit for this activity, participants must review all CME information, view all presentations in their entirety, and complete the Activity Evaluation Form.If you have any questions, please contact Arielle Gelardi at agelardi@crf.org.