Sensor-Guided Transcatheter Aortic Valve Replacement: An Interview With Josep Rodés-Cabau, MD, PhD

Dr Josep Rodés-Cabau shares background and insights on his paper, "Sensor-Guided Transcatheter Aortic Valve Replacement." Read the article here.

Transcript: 

Hello, I am Josep Rodes-Cabau, interventional cardiologist at the Quebec Heart and Lung Institute and professor at the Laval University in Quebec City, Canada, and I am the leading author of the paper that has been published in the Journal of Invasive Cardiology called Sensor-Guided Transcatheter Aortic Valve Replacement.

0:37: When were you first introduced to sensor-guided wire?

In fact, this is an interesting aspect. We have been working in different research projects in the field of transcatheter aortic valve replacement in TAVR and this is a sensor wire that was developed by a company which is very close to the hospital where we are working here in Quebec City - it's a company from Quebec called OpSens, and many years ago we met with them, and in fact, we were involved in the development of this guide wire from the very beginning with them.

And then we started using it, you know, first in the pre-clinical experiences and then in human cases and meaning that we have been involved and using this wire for a long time now.

1:55: What inspired your group to initiate this study?

There were 2 important aspects with this wire that we thought could be relevant to the TAVR procedures. First of all, when we started developing this guide wire is when all the left ventricular rapid pacing started instead of right ventricular rapid pacing, and this is a wire with specific pacing capabilities, allowing for left ventricular pacing.

This was one important aspect, meaning to facilitate the procedures, and to avoid the right ventricular pacing. But on the other hand, this wire has a pressure sensor at the distal end of the wire and this allows us to a continuous intraventricular pressure measuring during the procedures. We know that valve hemodynamics is important, and this wire allows us to evaluate continuously valve hemodynamics in TAVR procedures and can help us to guide, for example, post-balloon dilation in case of high gradient after, for example, a valve-in-valve procedure, or a significant article detected with this wire, meaning that it really provides a very elegant measurement, hemodynamic measurement continuously during the procedure, avoiding multiple exchanges with the with the catheters pulling back the wire. If you have to post dilate, inserting again the wire, you have your wire, you don't move the wire from the left ventricle, and you have all the hemodynamic information throughout the entire procedure. And this, we thought, could be a very interesting addition for the TAVR procedures.

4:31: Could you please give a brief overview of the study and your results? Did any results of the study surprise you?

There were no surprises. I would say that we started using this wire, and we initially reported, its use in 20 patients. Here we are reporting the results of a subsequent Canadian experience in 3 centers in Quebec, Montreal, and Vancouver and there were no surprises in all cases the transcatheter valve was implanted successfully. We had successful an effective rapid pacing in 98% of the cases under were no particular failures regarding this aspect, except for one patient that was a relatively young patient that was very difficult to have a significant decrease in blood pressure with left ventricular pacing, and we had to use right ventricular pacing, and in the vast majority of cases we obtained very precise, and I create a left ventricular pressure measurements with this wire, meaning that it worked well either for implanting the transcatheter valve, positioning the transcatheter valve, but also for the rapid pacing capabilities and for the recording of the ventricular pressures.

6:17: What advice would you give to cardiologists who are using this technology for the first time?

It would be probably the same advice that I could give when you are using left ventricular pacing. You have to be sure that your wire is well positioned, that it has not moved and sometimes it’s important to have one person only focused on the wire and ensuring that the wire is not going to move during rapid pacing. This is a rare situation, but for sure, these could translate into valve embolization, meaning that the most important advice would be to ensure an adequate positioning of the wire in the apex of the left ventricle and ensure that the wire is not moving while you are deploying the transcatheter valve. Apart from that, I think that this wire works very well as compared to the other available wires for TAVR procedures, and we did not experience any particular issues. Again, the only advice would be similar to other guide wires that we use in the TAVR space for left ventricular pacing to ensure that the valve is in an accurate position, and this allows us to have an effective drop in and blood pressure when rapid pacing in the left ventricle.

8:02: Do you foresee any additional future applications for this technology?

I see, I am quite convinced that in the TAVR field, in fact, is already a reality. We are already moving towards a simplification of the procedure. And this wire is definitely going to help in in this minimalist procedure approach. And this wire can also be used, maybe in other procedures, more in the right side, for example, when we are implanting pulmonary valves. We have been also using this wire when we are doing mitral valve implantations transfemorally for the rapid pacing. And this has been already reported successfully, meaning that there are other potential indications for this guide wire that was initially designed for TAVR procedures.

9:23: What can we look forward to seeing next from your group?

We are, in fact, that currently performing a randomized trial in the valve-in-valve TAVR space evaluating, or comparing in fact, the residual gradients measured by ECHO during the procedure vs residual gradients, valve hemodynamics measured invasively either with catheters but also with the SavvyWire. This is a trial called ECHOCAT. We have just started; 10 patients have been enrolled out of 310. And again, this is on a study that will provide interesting information about the usefulness of using invasive value hemodynamics vs echocardiographic measurements, particularly in the valve-in-valve space where a pressure recovery and significant differences between procedural gradients between ECHO and invasive hemodynamics can be observed.