The document discusses recent studies in interventional cardiology that have impacted daily practice. It focuses on structural heart disease and transcatheter aortic valve implantation (TAVI). It summarizes the results of the NOTION trial which found TAVI to be safe and effective compared to surgical aortic valve replacement in lower risk patients over 70 years of age. The document also discusses the PREVAIL trial which supported the safety and efficacy of left atrial appendage occlusion for stroke prevention in atrial fibrillation. Guidelines for left atrial appendage occlusion from the European Society of Cardiology may be updated based on recent data.

1. Estudios en cardiología intervencionista desde el último congreso
que han tenido un impacto en nuestra práctica diaria
Cardiopatía Estructural
Eduardo Infante de Oliveira
H. Santa Maria, Lisboa, Portugal

3. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI

4. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI

5. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI

6. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI

7. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI

8. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI

9. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI

10. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI

11. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI superiority vs. SAVR
US Corevalve Implication:
TAVI should be the preferred treatment for
patients with symptomatic severe AS at
increased risk for surgery
And what about intermediate risk patients?

12. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI in intermediate risk patients

13. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI in intermediate risk patients

14. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI in intermediate risk patients

15. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVITAVI in intermediate risk patients

16. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVITAVI in intermediate risk patients

17. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVITAVI in intermediate risk patients

18. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVITAVI in intermediate risk patients

19. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI
Lars Søndergaard
The Heart Center, Rigshospitalet, Copenhagen, Denmark
- on behalf of the NOTION Investigators
The NOTION Trial
TAVI in lower risk patients

20. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI
Nordic Aortic Valve Intervention
(NOTION) Trial
Objective:
Compare TAVI vs. SAVR in patients >70 years
eligible for surgery (all-comers population)
Primary
outcome:
Composite rate of death from any cause,
stroke or myocardial infarction at 1 year
(VARC II-defined)
Secondary
outcomes:
Safety and efficacy (NYHA),
echocardiographic outcomes
(VARC II-defined)
Design:
Prospective, multicenter, non-blinded,
randomized trial
Enrollment
period: December 2009 - April 2013

21. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI

22. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI
Characteristic, % or mean ± SD
TAVI
n=145
SAVR
n=135
p-
value
Age (yrs) 79.2 ± 4.9 79.0 ± 4.7 0.71
Male 53.8 52.6 0.84
STS Score 2.9 ± 1.6 3.1 ± 1.7 0.30
STS Score < 4% 83.4 80.0 0.46
Logistic EuroSCORE I 8.4 ± 4.0 8.9 ± 5.5 0.38
NYHA class III or IV 48.6 45.5 0.61
Baseline Characteristics

23. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI
Death from Any Cause, Stroke, or MI

24. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI
Death from Any Cause at 2 Years

25. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI
Secondary Outcomes at 2 Years

26. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI
Aortic Valve Regurgitation

27. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI
NYHA Class in Survivors

28. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI in lower risk patients
NOTION trial:
First trial to randomize lower risk patients
TAVI was safe and effective
TAVI was comparable to SAVR (death, stroke, MI)

29. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
TAVI - summary
Preferable to surgery in high risk patients (2-years FU)
Low mortality / complications rate in intermediate and low risk patients
Seems to be as safe and effective as SAVR in lower risk patients

30. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
LAA
One-sided 95% upper CI bound for
success
2.0% 2.5% 3.0%
Percent of patients experiencing an event
2.2%
2.618%
2.67%
Early Safety
95% upper CI bound for non-inferiority
0.5 1.0 1.5
18-month Rate Ratio
2.0
1.07
0.57 1.89
1.75
Primary Efficacy
95% upper CI bound for non-inferiority
-0.01 0 0.01
18-month Rate Difference
0.02
0.0053
-0.02 0.03-0.03
-0.0190
0.0273
0.0275
Late Ischemic Efficacy
Holmes, DR et al. JACC VOL. 64, NO. 1, 2014
PREVAIL trial
Left Atrial Appendage Occlusion

31. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
Left Atrial Appendage Occlusion

32. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
LAAO – ESC guidelines 2012 – Can we aspect changes?
Estado del arte del sistema de oclusión de orejuela izquierda
E. Infante de Oliveira, Hospital de Santa Maria, CHLN
European Heart Journal 2012 - doi:10.1093/eurheartj/ehs253
ESC 2012 A-Fib Guidelines Update

33. Cardiopatía Estructural Eduardo Infante de Oliveira, H. Santa Maria, Lisboa,
Portugal
LAAO – ESC guidelines 2012 – Can we aspect changes?
Estado del arte del sistema de oclusión de orejuela izquierda
E. Infante de Oliveira, Hospital de Santa Maria, CHLN
European Heart Journal 2012 - doi:10.1093/eurheartj/ehs253
ESC 2012 A-Fib Guidelines Update

34. Estudios en cardiología intervencionista desde el último congreso
que han tenido un impacto en nuestra práctica diaria
Cardiopatía Estructural
Eduardo Infante de Oliveira
H. Santa Maria, Lisboa, Portugal