Always paramount in planning strategy.
3D TOE now essential in ASD/LAA/PV leaks (especially mitral leaks. But the experienced operator could use ICE or 2D TOE.
TAVI is now mostly done with fluroscopy only. As ever, the imager and Interventionalist need to talk the same language.
Image integration in the lab (EchoNav, or CT) is still a dream for most of us due to the expense.
The IFRACODE registry showed quite convincing data to suggest balloon sizing is a good idea. Measuring the size in fluro on TOE depends on local expertise. After balloon sizing a larger device is usually placed- less embolization. No signal of erosion. Despite the erosion risk, all operators in the room would close ASDs with no aortic rim. Multiple devices might be needed, and that is acceptable.
The UK remains stymied by the Commissioning by Evaluation (CbE) process. Since EST 2016 2 more trials say it is a good idea!
Paravalvular Leak closure:
Much time was given to whether it is a paravalvar, or paravalvular leak! There was generational gap in naming. No conclusion was reached (I could not convince Shak to agree with me). Safe for the Hybrid Transapical approach vs a percutaneous approach. I look forwards to 2018 with a case of percutaneous transapical closure.
New TAVI valve come and some old ones go. But TAVI (TAVR) is here to stay. In Aortic stenosis, in Valve degeneration in aortic and mitral positions. And in some tricuspids too. Mitraclip has been hit in the UK by Commissioning by Evaluation (CbE) too. Other mitral technologies for MR under trial. The tricuspid valve has some solutions for severe TR- stents in IVC and SVC, clip on a new valve to the old leaflets, stick a spacer in the TV so coaptation is better, or bring leaflets together via annulus reduction. All challenging.
The current devices were reviewed- many on market. Again Commissioning by Evaluation (CbE) limiting use in UK. Safety is paramount if LAA closure is to be a real alternative to NOAC. There was little debate about doing it if anticoagulation was contraindicated, the CHADSVASC score was high, and you could get funding. Cases done with ICE and 3D TOE were shown. No one would recommend Fluro alone. A case of heroic retrieval and replacement was shown.
Interventions can be sued to fix congenital problems- PS, PR etc, and man made ones- PV stenosis after AF ablation for example. Some nice cases of AV fistulae being closed were shown. Have to be sure of the indication for intervention of course.
VSD an coarctation:
There was less focus on the post Infarct VSD this year. Use of novel devices or complex VSDs were discussed. Some fascinating recanalization of coarctations were shown. I was impressed by what Shak Qureshi can do- but then aren’t we all. I also learnt the origin of the TyShak balloon. Of course!
I hope you can join us in 2018. It will be another exciting meeting. Your participation is what makes it lively and educational.