Comments on: What We Believe http://cardious.com/weblog/post/907/ A Heart Technology Company Fri, 07 Oct 2011 14:48:47 +0000 hourly 1 http://wordpress.org/?v=3.0.4 By: Bob http://cardious.com/weblog/post/907/comment-page-1/#comment-41 Bob Tue, 24 Nov 2009 00:13:36 +0000 http://cardious.com/?p=907#comment-41 Re: high selling price Article in 22 Nov 09 St. Paul Pioneer Press notes revenue of Edwards - calculated currently at $27,000 +/-. This is unbelievable to me, now retired, but formerly employed by Medtronic and St. Jude Medical in positions with access to cost. Are they trying to recover their start-up costs in 2 years ? Is it any wonder that some congressmen/women want to impose a tax on medical device manufacturers ? Re: high selling price
Article in 22 Nov 09 St. Paul Pioneer Press notes revenue of Edwards – calculated currently at $27,000 +/-. This is unbelievable to me, now retired, but formerly employed by Medtronic and St. Jude Medical in positions with access to cost. Are they trying to recover their start-up costs in 2 years ? Is it any wonder that some congressmen/women want to impose a tax on medical device manufacturers ?

]]> By: Jim Pokorney http://cardious.com/weblog/post/907/comment-page-1/#comment-40 Jim Pokorney Tue, 17 Nov 2009 15:55:42 +0000 http://cardious.com/?p=907#comment-40 Thanks for providing your opinion. I appreciate your interest in the field. You make good "safety" arguments as to why AVB may be a better alternative for many patients. I believe safety along with "easy adoption" will be two key drivers to our success. As I said in this post, one of our fundamental beliefs is that AVB will be applicability to "all surgeons in all operating rooms anywhere in the world". I also agree - patients with severe AI are not good candidates for AVB. I understand this condition is not present in most AVR patients. Thanks for providing your opinion. I appreciate your interest in the field.

You make good “safety” arguments as to why AVB may be a better alternative for many patients. I believe safety along with “easy adoption” will be two key drivers to our success. As I said in this post, one of our fundamental beliefs is that AVB will be applicability to “all surgeons in all operating rooms anywhere in the world”.

I also agree – patients with severe AI are not good candidates for AVB. I understand this condition is not present in most AVR patients.

]]> By: Jay http://cardious.com/weblog/post/907/comment-page-1/#comment-39 Jay Tue, 17 Nov 2009 01:57:24 +0000 http://cardious.com/?p=907#comment-39 AVB is a great solution and it is unfortunate that many cardiac surgeons are not using it today. I believe the best aspect of AVB is not having to worry about the risks that TAVI introduces: occlusion of coronary ostia by bulky leaflets or low origin, stroke by manipulating the native calcified valve and arch, valve embolization, AR if not a tight fit, aortic rupture by aggressive oversizing, pace maker etc. Further, AVB relying on "off the shelf parts" with a standard valve mitigates the main concern of durability with a compressed transcatheter valve. That said, I personally know of an elderly man that had a TAVI with an Edwards valve. The TAVI procedure has had excellent results with no side effects 6 months post-op with significant improvement in QOL in this patient whom had near critical AS, severe AI, NYHA IV etc. An AVB option was explored, however with severe AI, AVB was not considered a viable option by the surgeons consulted. Hence in this instance, TAVI was deemed the only option for this elderly patient with a porcelain aorta and poor ileofemoral access. There is no doubt that AVB and TAVI will have their place in frail elderly patients that are deemed too high risk for traditional AVR. However, with upcoming transcatheter smaller sheaths and repositional retrievable valves, I believe AVB and TAVI procedures won't be the first choice when a total percutaneous femoral option exists for patients with good ileofemoral access and valve anatomy. This is similar to the coronary angioplasty versus coronary artery bypass preference by patients today. In summary, provided AVB can be safely performed without CPB in a suitable patient, I will predict that AVB will be selected over TAVI in patients with borderline valve anatomy concerns. AVB is a great solution and it is unfortunate that many cardiac surgeons are not using it today. I believe the best aspect of AVB is not having to worry about the risks that TAVI introduces: occlusion of coronary ostia by bulky
leaflets or low origin, stroke by manipulating the native calcified valve and arch, valve embolization, AR if not a tight fit, aortic rupture by aggressive oversizing, pace maker etc. Further, AVB relying on “off the shelf parts” with a standard valve mitigates the main concern of durability with a compressed transcatheter valve.

That said, I personally know of an elderly man that had a TAVI with an Edwards valve. The TAVI procedure has had excellent results with no side effects 6 months post-op with significant improvement in QOL in this patient whom had near critical AS, severe AI, NYHA IV etc. An AVB option was explored, however with severe AI, AVB was not considered a viable option by the surgeons consulted. Hence in this instance, TAVI was deemed the only option for this elderly patient with a porcelain aorta
and poor ileofemoral access.

There is no doubt that AVB and TAVI will have their place in frail elderly patients that are deemed too high risk for traditional AVR. However, with upcoming transcatheter smaller sheaths and repositional retrievable valves, I believe AVB and TAVI procedures won’t be the first choice when a total percutaneous femoral option exists for patients with good ileofemoral access and valve anatomy. This is similar to the coronary angioplasty versus coronary artery bypass preference by patients today.

In summary, provided AVB can be safely performed without CPB in a suitable patient, I will predict that AVB will be selected over TAVI in patients with borderline valve anatomy concerns.

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