Dr Malik presented at the recent ICI and CSI conferences in Frankfurt.
He presented a case of complex ASD (atrial septal defect) closure with a Figulla device. At the meeting many cases were presented covering techniques that are now prime time.
1. Left atrial appendage closure. Data was presented showing the use of the Amulet, ACP and Watchman devices. There is growing data that the ACP is an excellent device and lowers stroke risk compared to expected stroke rate depending of CHADSVAS score. There is already good data on the Watchman device. There was discussion about risk factors for clot formation. It appears key not to stop anti-platelet drugs too soon.
2. ASD closure. There are a range of devices, but the Figulla and Amplatser devices are the market leaders.
3. PFO closure. Dr Malik mentioned non device based closure with radio frequency ablation. This results on a 50:50 chance of closure. Device based closure is still the standard of care. It has a 95% closure rates. Should the PFO be closed? That is an individual patient based discussion but should only be considered in someone with a stroke, decompression illness or other serious health problem.
4. TAVI. Some great cases were shown. The Edwards and Corevalve systems are both used by Dr Malik.
5. Paravalvular leak closure. Some interesting data was shown using access from the neck to close mitral valve leaks, and percutaneous ( non surgical) mitral leak closure via the apex of the heart. Dr Malik recently did the first UK implant using the Occlutech paravalvular leak device.