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Implications of Low-Risk TAVR on the Future of Cardiothoracic Surgery

Tuesday, June 11, 2019

Nguyen TC, Lamelas J, Reardon MJ, et al.. Implications of Low-Risk TAVR on the Future of Cardiothoracic Surgery. June 2019. doi:10.25373/ctsnet.8226242.

CONTINUING MEDICAL EDUCATION CREDIT INFORMATION

Accreditation

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American College of Surgeons and Cardiothoracic Surgery Network. The American College of Surgeons is accredited by the ACCME    to provide continuing medical education (CME) for physicians.

AMA PRA Category 1 Credits™
The American College of Surgeons designates this live activity for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Of the AMA PRA Category 1 Credits™ listed above, a maximum of 0.5 credit meets the requirements for Self-Assessment.

 

PROGRAM OBJECTIVES

This activity is designed for cardiac surgeons in the United States. Upon completion of this course, participants will be able to describe the current indications for TAVR, assess the strengths and weaknesses of the recent low-risk TAVR trials results, and recognize the goal of SAVR in treating patients with severe aortic stenosis.

RELEASE, REVIEW AND TERMINATION DATE

  • Original release date: June 11, 2019
  • Most recent review: June 11, 2019
  • Termination date: June 10, 2020

DISCLOSURE POLICY

In accordance with the ACCME Accreditation Criteria, the American College of Surgeons must ensure that anyone in a position to control the content of the educational activity has disclosed all relevant financial relationships with any commercial interest. Therefore, it is mandatory that both the program planning committee and speakers complete disclosure forms. Members of the program committee were required to disclose all financial relationships and speakers were required to disclose any financial relationship as it pertains to the content of the presentations. The ACCME defines a ‘commercial interest’ as “any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients”. It does not consider providers of clinical service directly to patients to be commercial interests. The ACCME considers “relevant” financial relationships as financial transactions (in any amount) that may create a conflict of interest and occur within the 12 months preceding the time that the individual is being asked to assume a role controlling content of the educational activity.

The ACCME also requires that ACS manage any reported conflict and eliminate the potential for bias during the session. The planning committee members and speakers were contacted and the conflicts listed below have been managed to our satisfaction.  However, if you perceive a bias during a session, please advise us of the circumstances on the session evaluation form.

Please note we have advised the speakers that it is their responsibility to disclose at the start of their presentation if they will be describing the use of a device, product, or drug that is not FDA approved or the off-label use of an approved device, product, or drug or unapproved usage.

The requirement for disclosure is not intended to imply any impropriety of such relationships, but simply to identify such relationships through full disclosure, and to allow the audience to form its own judgments regarding the presentation.

Speakers / Moderators / Discussants

Nothing to Disclose

Disclosure

Company

Role

Received

Joseph E. Bavaria, M.D.

 

Edward Lifesciences

Primary Investigator

Research Grant

Medtronic Cardiovascular

Primary Investigator

Research Grant

Joseph Lamelas, M.D.

 

Medtronic

Speaker

Honoraria

Edwards

Speaker

Honoraria

LivaNova

Speaker

Honoraria

St. Jude/Abbott

Speaker

Honoraria

Miami Instruments

Partner

Honoraria

Michael Mack, M.D.

 

Edwards Lifesciences

Trial Co-PI

Null

Medtronic

Trial Co-PI

Null

Abbott

Trial Co-PI

Null

Michael J. Reardon, M.D.

 

Medtronic

Advisory Board

Funds for time go directly to department

Vinod Thourani, M.D.

 

Boston Scientific

Advisory Committee

Grant Support

Abbott Vascular

Advisory Committee

Grant Support

Edwards Lifesciences LLC

Advisory Committee

Grant Support

W.L. Gore and Associates

Advisory Committee

Grant Support

JenaValve

Advisory Committee

Grant Support

Richard J. Shemin, M.D.

 

Edwards Lifesciences

Scientific Committee Board Member

Honorarium

Planning Committee

Nothing to Disclose

Disclosure

Company

Role

Received

Mark K. Ferguson, M.D.

 

Springer

Royalties

Royalties

Elsevier

Royalties

Royalties

The Society of Thoracic Surgeons

Editorial Duties

Salary

Tom C. Nguyen, M.D.

 

Edwards Lifesciences

Speaker, Proctor

Honorarium

Abbott

Speaker, Proctor

Honorarium

Claire Vernon, Ph.D.

X

 

 

 

Educational Grants

CTSNet wishes to recognize and thank the following companies for their ongoing support through educational grants: Edwards Lifesciences.


In March 2019, two randomized trials were published comparing surgical (SAVR) and transcatheter aortic valve replacement (TAVR) in low-risk patients with severe symptomatic aortic stenosis: the PARTNER-3 Trial (Mack, et al., 2019; ClinicalTrials.gov number, NCT02675114) and the Evolute Low Risk Trial (Popma, et al., 2019; ClinicalTrials.gov number, NCT02701283).

Filmed at the 2019 AATS Annual Meeting in Toronto, Canada, Tom C. Nguyen of the University of Texas Houston in the USA moderates a discussion on the strengths and weaknesses of these recently published trials, focusing on the implications that these studies have for surgeons. Dr Nguyen is joined by Joseph Lamelas of the University of Miami in Florida, Michael Reardon of the DeBakey Heart and Vascular Center in Houston, Joseph Bavaria of the University of Pennsylvania in Philadelphia, Michael Mack of the Baylor Health Care System in Plano, Texas, Vinod Thourani of the Medstar Heart and Vascular Institute in Washington, DC, and Richard Shemin of the University of California Los Angeles.

In addition to detailing key elements of the studies and the reported primary endpoints, the panelists discuss the importance of the heart team and the critical role that it will play going forward as surgeons work to ensure the right procedure is performed for each patient. The group emphasizes the need for appropriate training so that surgeons are proficient at TAVR and able to collaborate within the heart team.

Dr Bavaria reviews the rationale for reopening and revising the TAVR National Coverage Decision (NCD) from the US Centers for Medicare and Medicaid Services (CMS). Additionally, Dr Shemin recommends that every surgeon read the expert consensus document from the AATS, the ACC, SCAI, and STS (Bavaria, et al., 2019), emphasizing that the better informed surgeons are, the better they will be able to serve both their patients and the surgical profession. The panelists highlight work that was and is being done by the societies to share feedback for the NCD as well as to provide educational opportunities for surgeons interested in developing or enhancing their transcatheter skills.

Finally, each panelist provides their thoughts on the question: “Ten years from now, what will be the role of surgeons in treating structural heart disease?”

References

Bavaria JE, Tommaso CL, Brindis RG, et al. 2018 AATS/ACC/SCAI/STS expert consensus systems of care document: operator and institutional recommendations and requirements for transcatheter aortic valve replacement: a joint report of the American Association for Thoracic Surgery, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Thorac Cardiovasc Surg. 2019;157(3):e77-e111.

Mack MJ, Leon MB, Thourani VH, et al, for the PARTNER 3 Investigators. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380:1695-1705.

Popma JJ, Deeb GM, Yakubov SJ, et al, for the Evolut Low Risk Trial Investigators. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med. 2019;380:1706-1715.


To complete the posttest and claim CME credit for this activity, please click the following link or copy it into a new tab in your browser:

https://www.surveymonkey.com/r/98WRDYZ

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