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TAVI - STOP PRESS!

April 2014
In a randomised trial of 800 patients high-risk patients with severe aortic stenosis, 50% of patients were treated using surgical valve replacement and the other 50% were treated with transcatheter aortic valve replacement. After 1 year of having the treatment, the trial findings showed:
  • There were 5% more deaths (from all causes) in the patient-group who had had the surgical valve replacement treatment;
  • There were 4% more strokes in patient-group who had the surgical valve replacement treatment;
  • There was a significantly higher proportion of patients who had life-threatening bleeding in the patient-group who had the surgical valve replacement treatment; and
  • There was also a significantly higher proportion of patients who had new or worsening atrial fibrillation in the patient-group who had the surgical valve replacement treatment.
Refer to the slide show below for more information regarding the trial findings.

Click here for further information on Transcatheter Aortic Valve Implantation (TAVI) at Mercy Angiography.
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Renal Denervation for Resistant Hypertension

24 June 2014
 
Renal Denervation is a new procedure to treat resistant hypertension. The team at Mercy Angiography led by Dr John Ormiston is the first in New Zealand to provide this treatment.

The first generations of renal denervation devices involved passing a tube from a groin artery to the renal artery and quietening the sympathetic nerves to the kidney by “zapping” them with radio frequency energy. While early trials showed important reduction in blood pressure, a recent trial has raised doubts.

We now offer as part of a trial (patients are not charged) a completely non-invasive technology that uses special ultrasound. There is no blood loss and no x-rays. We have not encountered side effects except pain at the time of the procedure and sometimes on-going mild discomfort afterwards. This is usually of short duration. There has been an important reduction in blood pressure.

Potential patients will need a consultation. Your family doctor or specialist may wish to refer directly to us at Mercy Angiography or to an Auckland Heart Group Cardiologist for an assessment of need and suitability. There will be a consultation, blood tests, blood pressure monitoring tests and imaging.

For more information regarding the current trial procedure, please read this New Zealand Herald Article: Hope for blood-pressure patients or refer to Kona Medical's website. You can also contact Mercy Angiography using the details provided below.

For more information regarding the first generation procedures, refer to the documentary featured on TV One’s Sunday programme on 17th June, 2012. 
 

Contact Details

Mercy Angiography Unit Ltd

Telephone: +64 9 630 1961 
Fax: +64 9 630 1962
Email: admin@mercyangiography.co.nz
After hours: +64 274 820 763
Auckland Heart Group

Telephone: +64 9 623 1020 
Fax: +64 9 623 2845
Email: ahg@heartgroup.co.nz
Website: www.heartgroup.co.nz
 
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Renal Denervation for Resistant Hypertension

11 April 2014
 
The Symplicity III trial while reaching its safety endpoint did not reach its efficacy endpoint. 
 
At Mercy Angiography we are currently involved with and recruiting patients for a very interesting trial where denervation is completely non-invasive and uses externally applied ultrasound to damage the renal sympathetic nerves. It seems very effective and  does not seem to have side effects. This approach has much promise and patients appear to have nothing to lose as it is non-invasive and appears very safe and preliminary results show it is effective. A larger sham trial is being planned. Patients and staff do not know whether the patient is in the treatment or control arm. This is very easy to do with this non-invasive trial using ultrasound.  After a period the control arm patients are given the option to have the treatment.
 
The European Society of Hypertension's comment on SYMPLICITY HTN -3 results: The Symplicity III trial where patients were randomized to renal denervation with the Symplicity device or a sham treatment failed to reach its primary efficacy endpoint.  It was not better than the control arm.
 
"The European Society of Hypertension believes that although in the Symplicity HTN-3 study use of an appropriate control group makes the results less open to confounders than those of previous studies, the conclusion that renal denervation is ineffective is not justified.
 
One, given the multifactorial contribution of renal nerves to blood pressure elevation, renal denervation has a strong pathophysiological rationale.
 
Two, albeit in a less well controlled fashion, several studies have found renal denervation to be accompanied not only by sizeable blood pressure reduction, but also by an improvement of biomarkers that have been shown to be prognostically relevant in individuals with a blood pressure elevation .

Three, there are in the Symplicity HTN-3 study data, such as the greater blood pressure effects of renal denervation in non-African Americans, that suggest that the procedure may be effective in specific subgroups.
 
Thus, the reaction to the negative results of the Symplicity HTN-3 study should not be to abandon the renal denervation approach but to perform further studies of high scientific calibre that could provide further evidence on its overall position in the treatment of resistant hypertension, determine whether the blood pressure effects are limited to some patients' subgroups (and clarify their characteristics), and see whether and to what extent their blood pressure reductions translate into cardiovascular and renal protection. Although the true prevalence of resistant hypertension is still uncertain, there is no question that in an overall high number of individuals current drug treatment is not effective and that the risk of these individuals to develop cardiovascular and renal complications is high. This represents an important unmet therapeutic need that research should continue to address, without prematurely abandoning  approaches that rationale and background preliminary data allow to consider one of the possible solutions."
 
REFERENCES
 
1.  Bhatt DL, Kandzari DE, O'Neill WW, D'Agostino R,  Flack JM, Katzen MT, Leon MB, Liu M, Mauri L, Negoita M, Cohen S.A., Oparil S, Rocha-Sing K, Townsend RR and Bakris GL. A controlled trial of renal denervation for resistant hypertension. N Engl J Med 2014, published on March 29, doi:10.10567nejmoa1402670
2.  Messerli FH, Bangalore S. Renal Denervation for Resistant Hypertension? N Engl J Med. 2014, published on March 29. [Epub ahead of print]
 
 
Professor John Ormiston
MBChB,FRACP,FRACR,FCSANZ,FAPSIC,FRCP, FACC, ONZM


 
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