Editor’s 2024 Top 10: Sensor-Guided Transcatheter Aortic Valve Replacement
Dr Deepak L. Bhatt, editor-in-chief of the Journal of Invasive Cardiology, catches up with Dr Josep Rodés-Cabau about his Editor’s 2024 Top 10 article, “Sensor-Guided Transcatheter Aortic Valve Replacement”.
Transcript:
Dr Bhatt: Hello, I'm Dr. Deepak Bhatt, the Editor-in-Chief of the Journal of Invasive Cardiology, and I'm really fortunate to have today one of interventional cardiology's real leaders, Dr Rodés-Cabau, who is an interventional cardiologist at the Quebec Heart and Lung Institute and a professor at Laval University. There's an article that he was the senior author on that has made the top 10 list for 2024 for the Journal of Invasive Cardiology that I thought was really an interesting article that's using a wire during TAVR that allows both the measurement of the pressure gradient but also pacing, sort of one-stop shopping to do everything that we need to do during TAVR other than the TAVR itself, so, it seemed like a clever device. Do you want to tell us a bit of what your study found?
Dr Rodés-Cabau: Yes, thank you very much, Dr Bhatt, for the interest in our article. And the main findings were that this wire worked very well in terms of continuous pressure recording in all cases; there were 60 cases in 3 centers in Canada. And in addition to this, this wire has the pacing capabilities, and the rapid pacing that we used in the procedure was also successful in the vast majority (98%) of cases, with a significant drop in blood pressure, meaning that this wire seems to be very useful and could probably replace the temporary pacing at the right ventricle that has been used in the past for rapid pacing during TAVR procedures.
Dr Bhatt: Right, and in case anyone listening is trying to figure out which wire: this is a SavvyWire by OpSens Medical — they funded this study. It's a 0.035-inch wire exchange length, and it's also a pre-shaped wire. So it's got a nice safe rounded tip, so it doesn't penetrate through the LV. In using the wire, did you encounter any complications with it or did it seem like a typical sort of 0.035 wire for TAVR?
Dr Rodés-Cabau: Exactly. I would say it performed at least similar to the wires that we usually use in these cases. In fact, the patients included in the studyrepresented real-world practice, meaning that there were a significant number of horizontal aorta cases, vascular tortuosity, etc, and it performed well in all cases, meaning that, apart from these pressure recording and pacing capabilities, the wire performs very well in terms of facilitating the advancement and positioning of the transcatheter valve.
Dr Bhatt: So then someone would cross into the LV with whatever catheter they like, maybe an Amplatz or whatever wire they like to get in there, and then would exchange out with this wire and then go ahead and do their procedure. Is that right?
Dr Rodés-Cabau: Exactly. And then when you have implanted the valve, you have a direct pressure measurement without the need of replacing the wire with a pigtail, meaning that in some instances, for example valve-in-valve cases where sometimes you may require balloon post-dilation or even surgical ring fracture, this can be particularly useful in terms of avoiding many exchanges of the wire with the pigtail.
Dr Bhatt: It seems like it should speed up procedures. I mean, TAVR operators have gotten a lot faster, but this seems like it could add further time savings and just reduce the complexity, the number of steps. In terms of the pacing, was there any issue with it? Because it's a bit of a curve wire at the end, but if it's in contact with the LV…
Dr Rodés-Cabau: Yes. I think that in all cases, you have really to ensure that the wire is in good contact, that the wire is not in the middle of the left ventricle, is really at the apex. And my advice would be always to have someone taking care of the wire when we do the rapid pacing. If you do so, the pacing works very well in the vast majority of cases.
Dr Bhatt: Right. In terms of complications like LV perforation or loss of capture, that didn’t really seem to be an issue in your study. Is that fair to say?
Dr Rodés-Cabau: No, not really. And in fact, this has changed also even with other wires; with these pre-shaped wires, I think that we are seeing less and less these kinds of ventricular perforations that we may have had in the past with the non-pre-shaped wires.
Dr Bhatt: Any other tips or tricks with dealing with this wire or any other observations you want to make about the evolution of TAVR?
Dr Rodés-Cabau: I think that, again, this goes into the direction of a minimalist approach for TAVR, it’s another step forward in this direction. And I think that having tools like this one is useful in order to move towards this direction.
Dr Bhatt: I agree with you. It really does have the potential to further simplify the procedure. So, congratulations on this work and thanks for publishing in the Journal of Invasive Cardiology.
Dr Rodés-Cabau: Thank you very much.
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