Dave Fornell, DAIC Editor

Dave Fornell, editor of DAIC Magazine

Blog | Dave Fornell, DAIC Editor | September 26, 2014

Trends and New Data at TCT 2014

By Dave Fornell, editor of DAIC Magazine

The key take away messages from the 26th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium were bioresorable stents and transcatheter valve technologies will likely become primary interventional tools in the near future. These two areas were among the hottest topics of discussion in sessions, live case presentations, late-breaking trials and on the expo floor. The latest trial data for both technologies presented at TCT continue to show extremely positive trends in patient outcomes that are equal or better than current standards of therapy. 

Key news on bioresorbable stents at the meeting came from the ABSORB II Trial, which compared the Abbott Absorb BVS drug-eluting bioresorbable stent to the company's market-leading Xience metalic drug-eluting stent. At one year the clinical outcomes were the same, but the bioresorbable stent patients reported a significantly lower incidence of angina. This opens up an entirely new avenue of research into these devices and their potential benefits. This inspired changes in the upcoming ABSORB IV trial to examine angina outcomes specifically. Watch a video discussing these findings and the future of bioresorbable stents. 

There were several trial presentations of transcatheter aortic valve replacement (TAVR), including long-term outcomes and economic impact of using these devices (see news items below). One of the key issues with TAVR has been stroke rates higher than surgical valve replacements, and three start-up companies showed cerebral embolic protection devices at TCT. The biggest news in this area was from a trial involving the Claret device, which resulted in a lower stroke rate. Here is an article overview of the TAVR embolic protection devices in development

I attended one packed, standing-room-only session on transcatheter mitral valve replacement devices in development. This is definitely the next technology area to watch, as I suspect this will become the next major technology highlighted at future ACC and TCT meetings.

I highlighted the details of two technologies that may offer paradigm shifts in interventional cardiology in the next couple years in a video about intravascular imaging to detect vulnerable plaque, and a video about CT-FFR.

There were many cutting-edge technologies highlighted at TCT. I offer a roundup of these in my video "DAIC Editor's Choice of the Most Innovative New Technologies at TCT 2014."

 

Related Content

FDA Approves Sapien 3, CoreValve Evolut TAVR Valves for Low-risk Patients

Left, an illustration of the beginning of deployment for a CoreValve Evolut self-expanding transcatheter aortic replacement (TAVR) valve. Right, an illustration of the final balloon expansion of an Edwards Lifesciences Sapien 3 TAVR valve. Both valves received simultaneous FDA clearance for use in low-risk surgical patients. Clearing this last hurdle now allows wide-spread use of minimally invasive TAVR in all patients who otherwise would need an open-heart surgical valve replacement. 

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Study Shows Inducing a Heart Attack Helps Valve Patients. This image shows a left-ventricular outflow tract (LVOT) obstructed by an Edwards Sapien TAVR valve used for a valve-in-valve procedure. The arrow points to the small, crescent shaped dark area of the neo-LVOT, which did not allow enough blood to flow from the left ventricle into the aorta and the rest of the body. To prevent this issue, the procedure used by Henry Ford ablates some of the tissue in the septum to allow for a larger LVOT area.

This image shows a left-ventricular outflow tract (LVOT) obstructed by an Edwards Sapien TAVR valve used for a valve-in-valve procedure. The arrow points to the small, crescent shaped dark area of the neo-LVOT, which did not allow enough blood to flow from the left ventricle into the aorta and the rest of the body. To prevent this issue, the procedure used by Henry Ford ablates (kills) some of the tissue in the cardiac septum to allow these valves to fit better and allow for an enlarged neo-LVOT for patients who otherwise could not receive this therapy. 

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The MitraClip is one example of a transcatheter mitral valve repair or replacement (TMVR) device used in the structural heart repair program at Henry Ford Hospital.

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Illustration showing the catheter steps for the LAMPOON procedure designed to prevent left ventricular outflow tract (LVOT) obstruction . From Dr. Jaffar M. Khan and the Laboratory of Cardiovascular Intervention, led by Dr. Robert J. Lederman.

Figure 1: Illustration showing the catheter steps for the LAMPOON procedure. From Dr. Jaffar M. Khan and the Laboratory of Cardiovascular Intervention, led by Dr. Robert J. Lederman.

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