The evolution, current status and future development of percutaneous therapies for valvular heart disease Ted Feldman, M.D., MSCAI FACC FESC Evanston Hospital 2017 Carl J. Wiggers Memorial Lecture April 19th, 2017 Cleveland, Ohio Ted Feldman MD, MSCAI FACC FESC Disclosure Information The following relationships exist: Grant support: Abbott, BSC, Cardiokinetics, Corvia, Edwards, WL Gore Consultant: Abbott, BSC, Edwards, WL Gore Stock Options: Mitralign Off label use of products and investigational devices will be discussed in this presentation Symptomatic AS Is a Malignant Disease 5-Year Survival 35 30 30 28 25 23 ) % ( 20 l a v i v 15 r u 12 S 10 4 5 3 0 Breast Lung Colorectal Prostate Ovarian Severe Cancer Cancer Cancer Cancer Cancer Inoperable AS* • 5-year survival of breast cancer, lung cancer, prostate cancer, ovarian cancer, and severe inoperable AS is reported here Analysis courtesy of Murat Tuczu, MD, Cleveland Clinic. Approved in the US Medtronic CoreValve Edwards Lifesciences Evolut R S3 STS Risk Distribution STS 4- upper third Intermediate Risk Low Risk STS 8- upper decile High & Extreme Risk +1S +2S +3S Frailty: Katz ADL: feeding,bathing,dressing,transfer,toilet & urinary continence LOW Risk: STS<4% and no frailty or major organ compromise INTERMEDIATE Risk: STS 4-8% or mild frailty or 1 major organ compromise HIGH Risk: STS>8% or moderate frailty or 2 major organs compromised PROHIBITIVE Risk: Risk of death or major complication at 1 year >50% or 3 major organs compromised Contemporary Real-World Outcomes of Surgical AVR in 141,905 Low-Risk, Intermediate-Risk, & High-Risk Patients- 2002 to 2010 120000 100000 s t n e 80000 i t a P f 60000 o r e b m 40000 u N 20000 0 <4% 4-8% >8% Baseline STS PROM Mean Age 65 77 77 Median STS 1.46% 5.24% 11.2% Operative Mortality 1.4% 5.1% 11.9% Ann Thorac Surg 2015;99:55–61 www.sts.org