Exploring the in-depth analysis of 7-year data from the COMMENCE trial
Joseph Bavaria
Prof. D’Onofrio
Aortic Highlights course
Prof. Girdauskas
Aortic Highlights course, 2023
Prof. Kalavrouziotis
Edwards Lifesciences at EACTS 2022: State of the art in the treatment of aortic valve regurgitation in young patients
Dr. Girdauskas
MVT Aortic 2022, vol.2
Prof. Martin Andreas
MVT Aortic 2022, vol.2
– There are different centers and different techniques, but do they share the same outcomes?
– Be sure to catch his explanation about what makes decellularized heart valves so unique.
– Proper skills and robust training are key.
Prof. Alessandro Della Corte
MVT Aortic 2022, vol.1
– Patients with an “ascending” phenotype? A separate vale and ascending graft replacement procedure is an option
– Patients with a “root” phenotype? Consider addressing the root earlier (50 mm root diameter)
– Bentall is still the gold standard, but valve-sparing procedures have similarly good results
Prof. Ruggero De Paulis
MVT Aortic 2022, vol.1
– First and foremost, not all bicuspid aortic valves are the same
– Many post-operative measurements and goals are included within to help guide you to optimal patient outcomes
– Check out the insight provided about valve-sparing, valve repair, external annuloplasty, and more
Prof. Alessandro Della Corte
MVT Aortic 2022, vol.1
– New classification system and nomenclature of bicuspid aortic valve (and bicuspid aortic valve disease)
– Genes are important, but a single gene may contribute to fewer than 1% of cases
– Different valve repair techniques according to valve phenotype
Prof. Michael Borger
MVT Aortic 2022, vol.1
-The “aortic size paradox”: an interesting paradox, indeed
-Length? Diameter? Which should we pay more attention to?
-Be sure to pay attention to genetics, biomarkers, abnormal flow, other risk factors, and more
The recently updated ESC/EACTS Guidelines contain two key changes in the recommendations for prosthetic valve selection:1
- A new Class IIb recommendation for bioprostheses in patients already on long-term NOACs
- An upgraded Class I recommendation for bioprostheses in patients for whom good-quality anticoagulation is unlikely or contraindicated, and in patients whose life-expectancy is lower than the presumed durability of the valve
Importantly, the desire of the informed patient remains central to prosthetic valve selection. Valve durability in young patients is an important consideration, but long-term data on bioprosthetic SAVR have been limited.
INDURE registry
INDURE is a prospective, open-label, multicentre registry that is tackling this issue head-on. INDURE has enrolled over 400 patients aged up to 60 years who are undergoing SAVR with the INSPIRIS RESILIA valve in 21 sites across Europe and Canada. Patients are being followed up for five years, with echocardiograms analysed by Echo Core Laboratory at years one and five.2,3
One-year results from the first 435 patients were reported at the 2021 EACTS Annual Meeting. Younger patients (up to 50 years old) in the registry were more likely to have a bicuspid aortic valve or aortic valve regurgitation at baseline than patients aged 51–60 years, but were less likely to have aortic stenosis, hypertension or diabetes.3
Excellent haemodynamic outcomes at 1 year
The excellent haemodynamic outcomes were comparable in the younger and older patient groups.
Plus, preliminary safety outcomes demonstrated low all-cause mortality and no confirmed cases of valve-related mortality up to one year. Rates of endocarditis and stroke were low (<1%). There were no cases of stage 3 SVD.
The INDURE registry will continue to provide clinical evidence on the use of the INSPIRIS RESILIA valve in young patients for the next 5 years.
References
1. Vahanian A, Beyersdorf F, Praz F et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg. 2021.
2. Meuris B, Borger MA, Bourguignon T et al. Durability of bioprosthetic aortic valves in patients under the age of 60 years – rationale and design of the international INDURE registry. J Cardiothorac Surg. 2020; 15: 119.
3. De Paulis R. Surgical aortic valve replacement in patients under 60 years old: A prospective, multicentre real-world registry in Europe and Canada. EACTS 2021.
For professional use. For a listing of indications, contraindications, precautions, warnings, and potential adverse events, please refer to the instructions for Use (consult eifi.edwards.com where applicable)
Edwards devices placed on the European market meeting the essential requirements referred to in Article 3 of the Medical Device Directive 93/42/EEC bear the CE marking of conformity.
Edwards, Edwards Lifesciences, the stylized E logo, INSPIRIS, and RESILIA are trademarks or service marks of Edwards Lifesciences Corporation or its affiliates. All other trademarks are the property of their respective owners.
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Edwards Lifesciences • Route de l’Etraz 70, 1260 Nyon, Switzerland • edwards.com
Prof. Alfred Kocher
MVT Aortic 2021
Prof. Ruggero De Paulis
MVT Aortic 2021
Prof. Alfred Kocher
MVT Aortic 2021
Dr. Alain Berrebi
MVT Aortic 2021
