Complication Of Transcatheter Aortic Valve Implantation Research Articles

Post-procedural myocardial infarction following surgical aortic valve replacement and transcatheter aortic valve implantation

Myocardial injury assessed using cardiac biomarker release is ubiquitous following surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI), preventing accurate discrimination between focal myocardial infarction (MI) and global injury. Cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) imaging was used to compare rates of new MI following SAVR and TAVI. Identical CMR scans were obtained at baseline and six months post procedure in ninety-six patients undergoing SAVR (n=39) and TAVI (n=57). The rate of new MI was greater following SAVR than TAVI (SAVR, n=10 [26%] vs. TAVI, n=3 [5%], p=0.004). Infarct mass was similar between groups (SAVR 1.1±0.6 vs. TAVI 2.0±1.4 g, p=0.395). New MI did not impact on change in LV ejection fraction (SAVR:LGE[+]2.2±4.7 vs. LGE[-]0.9±8.0%, p=0.437, TAVI:LGE[+]-0.9±6.0 vs. LGE[-]2.0±7.8%, p=0.420). Thirty-four patients (60%) in the TAVI group had non-revascularised coronary artery disease (CAD) at the time of TAVI, of whom three (9%) had new MI. MI is an infrequent complication of TAVI but is more common following SAVR. Infarct size is small following both procedures. The low new infarct rate in TAVI, especially in the context of high rates of non-revascularised CAD, strengthens data from previous studies suggesting that coronary revascularisation pre-TAVI may be unnecessary.

Management and Outcome of Transcatheter Aortic Valve Implantation Requiring Surgical Intervention Focusing on the Time Interval between Complication Onset and Establishing Cardiopulmonary Bypass

Objectives: Complications during transcatheter aortic valve implantation (TAVI) might require surgical intervention and in severe cases cardiopulmonary bypass (CPB). Therefore, it is still mandatory to perform TAVI-procedures in a heart team, consisting of a heart surgeon and interventional cardiologist to increase patient survival. We aim to look at the management and outcome of TAVI complications requiring surgical intervention at our institution.

Patient selection for TAVI in 2016: should we break through the low-risk barrier?

The earliest evidence supporting transcatheter aortic valve implantation (TAVI) was derived from its comparison with conservative therapy in inoperable patients and with surgical aortic valve replacement (SAVR) in extremely high risk patients. TAVI had a relative advantage in these situations being less invasive and hence less prone to the classic early postoperative devastating complications. To prove as effective in less fragile and less morbid patients, the long-term durability of the haemodynamic and clinical gains from TAVI needs to be confirmed. In this report we will discuss three aspects of the dilemma of expanding TAVI indications to lower-risk patients: first, available data on early and late outcomes after TAVI; second, durability issues; and third, TAVI complications and procedural refinements.

Incidence and Clinical Impact of Stroke Complicating Transcatheter Aortic Valve Implantation: Results From the German TAVI Registry.

Transcatheter aortic valve implantation (TAVI) has emerged as a safe and effective treatment for patients with severe, symptomatic aortic valve stenosis at high surgical risk over the last years. However, besides its minimal invasive character, TAVI still is an invasive procedure usually performed in a population, carrying a substantial risk for vascular complications, like stroke. Stroke is known to be a rare but serious complication of transvascular interventions in clinical practice, which is associated with high morbidity and mortality rates. Despite broad clinical research in many fields of TAVI over the last years, only sparse data still exist on the incidence and clinical risk factors of stroke complicating TAVI in clinical practice today. We analyzed data of 1.413 TAVIs, which were enrolled at 30 sites into the prospective and multicenter German TAVI Registry from January 2009 until June 2010. The overall incidence of cerebrovascular events complicating TAVI was 3.2% (n = 45/1.413) in a real-world population today. 40% of all cerebrovascular events were classified as transient ischemic attacks (TIA) with symptoms lasting < 24 hr (18/45) and 60% were classified as stroke with symptoms persisting > 24 hr (27/45). All strokes complicating TAVI of 50% were classified as major strokes leading to notable disability in patients, who survive this complication (Modified Ranking Scale 3-6). In-hospital mortality rate in patients with stroke/TIA was 28.9%, compared to 6.9% in patients without stroke/TIA and 1-year mortality rate 46.7% versus 18.6%, respectively. In multivariate analysis, prior stroke and renal impairment were found as the only independent predictors for stroke complicating TAVI. Stroke complicating TAVI is a serious complication with a clinically relevant incidence even in daily practice leading to a fivefold increase in 30-day-mortality rate, as well as a significant increase in morbidity and disability in patients, who survive this devastating complication. Further research is needed to identify risk factors and ways to reduce stroke after TAVI. © 2016 Wiley Periodicals, Inc.

Transcatheter aortic valve implantation (TAVI) in Germany 2008-2014: on its way to standard therapy for aortic valve stenosis in the elderly?

In Germany, all transcatheter aortic valve implantations (TAVI) and surgical aortic valve replacements (sAVR) are registered within an obligatory quality assurance programme led by the independent AQUA Institute. We have summarised patient and procedural characteristics, complication and mortality rates as reported in the annual, German language AQUA quality reports, freely accessible online, in order to provide a comprehensive overview of developments between 2008 and 2014. Since 2008, a total of 71,927 isolated sAVR and 48,353 TAVI procedures have been performed in Germany. The numbers of sAVR are steadily declining (2008: 11,205; 2014: 9,953). For TAVI, there has been a 20-fold increase since 2008, from 637 to 13,264 procedures in 2014, surpassing the annual numbers of isolated sAVR since 2013. The age profile of TAVI patients has remained unchanged over time (mean age: 80.9 years), with a recent trend towards lower-risk/intermediate-risk patients. TAVI complications are rapidly decreasing (2012: 9.4%; 2014: 3.9%); annular rupture, aortic dissection and coronary occlusions are rare (<0.3%), with fewer patients requiring surgical conversion to sternotomy (2012: 1.2%; 2014: 0.6%). In-hospital mortality after TAVI has halved in 2014 (4.2%) compared with 2008 (10.4%). Real-world clinical data from the obligatory quality assurance programme document the rapid adoption of TAVI in Germany, shifting treatment of aortic valve stenosis in the elderly from surgery to a catheter-based approach. Since 2008, similar to what happened with PCIs, complications of TAVI have declined considerably along with the need for emergency cardiac surgery. Most importantly, in-hospital mortality has halved from 2008 to 2014, while mortality for sAVR has remained unchanged.

Silent coronary obstruction following transcatheter aortic valve implantation: Detection by transesophageal echocardiography

In several recent guidelines, transcatheter aortic valve implantation (TAVI) has been recommended as a therapeutic option for inoperable or high surgical risk patients with severe aortic stenosis. TAVI has various specific complications that seldom occur in surgical aortic valve replacement. Among them, coronary obstruction (CO) is an infrequent but serious complication. Previous case series have reported symptomatic CO cases diagnosed by hemodynamic instability, electrocardiographic changes, and abnormal findings on aortography. We report a case of silent CO in an 86-year-old female. Monitoring of coronary flow by transesophageal echocardiography led to a diagnosis of CO. Silent CO is probably an underdiagnosed complication of TAVI.<Learning objective: Coronary obstruction is an infrequent but serious complication of transcatheter aortic valve implantation (TAVI). Previous case series have reported only symptomatic coronary obstruction cases diagnosed by hemodynamic instability, electrocardiographic changes, and abnormal findings on aortography. Transesophageal echocardiography monitoring of coronary ostium flow is useful for detecting coronary obstruction. Silent coronary obstruction is probably an underdiagnosed complication of TAVI.>

Post TAVI complications – a pictorial review

Purpose Transcatheter aortic valve implantation (TAVI) has emerged for treating aortic stenosis in patients who are poor candidates for surgical aortic valve replacement. Although a promising approach for high-risk patients, the indication may be expanded to intermediate- and eventually low-risk patients in the future; however, doing so will require a better understanding of potential complications. In the current presentation, we present our institutional experience of postoperative complications such as myocardial infarction, stroke, bleeding, vascular complications and valve performance. Malpositioning, valve migration/embolisation and conversion to open surgery are other potential complications following TAVI which will be presented. Methods and materials N/A Results N/A Conclusion N/A Transcatheter aortic valve implantation (TAVI) has emerged for treating aortic stenosis in patients who are poor candidates for surgical aortic valve replacement. Although a promising approach for high-risk patients, the indication may be expanded to intermediate- and eventually low-risk patients in the future; however, doing so will require a better understanding of potential complications. In the current presentation, we present our institutional experience of postoperative complications such as myocardial infarction, stroke, bleeding, vascular complications and valve performance. Malpositioning, valve migration/embolisation and conversion to open surgery are other potential complications following TAVI which will be presented. N/A N/A N/A

Transcatheter Aortic Valve Implantation: An Introduction and Patient Care

Aortic stenosis has a high prevalence among individuals over 75 years of age. Transcatheter aortic valve implantation (TAVI) is a novel valve-replacement technique for patients with multiple chronic diseases who are at high risk of requiring aortic valve replacement surgery. Most of the time, the indicators of TAVI are detected during an echocardiographic exam. The femoral artery is the primary insertion site. The complications of TAVI include stroke, vascular dissection, bleeding, aortic valve regurgitation, and arrhythmia. In terms of clinical effectiveness, the mortality rate of TAVI is lower than percutaneous ballon valvuloplasty but similar to AVR. The unplanned cardiac-related re-admission rate within 30 days of discharge is lower for TAVI than for AVR. In terms of activity tolerance, TAVI is significantly better than both percutaneous ballon valvuloplasty and AVR. Comprehensive nursing care may reduce the incidence of complications associated with TAVI. Nursing care of TAVI includes explaining and providing instructions regarding TAVI prior to the procedure. After the TAVI procedure and while the patient is in the ICU, remove the endotracheal tube as soon as possible, monitor his / her neuro-cognitive status, monitor for early detection of a stroke event, record urine output to assess renal function, observe bleeding in the puncture site, and evaluate cardiac arrhythmia and pain. While in the general ward, resume early physical activities and educate the patient regarding the risks and the prevention of bleeding. This article provides references for clinical staff responsible to care for post-TAVI surgery patients.

Safety of transcatheter aortic valve implantation in a hospital with visiting on-site cardiac surgery.

To describe the feasibility and safety of transcatheter aortic valve implantation (TAVI) with a visiting on-site cardiac surgery program for surgical back-up. Both European and American guidelines recommend institutional cardiac surgery back-up for TAVI. However, the conversion to cardiac surgery is very rare, many complications of TAVI can be managed by catheter techniques and a visiting team can also provide surgical stand-by. Therefore, the need for institutional cardiac surgery (by a surgeon who routinely performs conventional surgical valve replacement at the institution performing TAVI) has been questioned. A retrospective review of consecutive TAVI cases with visiting on-site cardiac surgery was performed. Key demographic, echocardiographic, and procedural data were collected prospectively. A total of 97 patients (81.9 ± 6.3 years) with high-risk criteria (log Euroscore 21.6 ± 14.4, chronic renal failure 39.2%, severe systolic dysfunction 24.7%) underwent TAVI with visiting on-site cardiac surgery at our institution. Local anesthesia with or without conscious sedation was used in 94.8% of patients. Procedural technical success was 100%, with 2 episodes of tamponade (both treated with pericardiocentesis) and a 16.5% vascular complication rate (all treated conservatively or percutaneously). Thirty-day mortality was 3.1%, with 5.2% rate of stroke and 8.2% rate of major bleeding. There were no conversions to surgery. TAVI can be done safely in the setting of a hospital with visiting on-site cardiac surgery. This requires careful patient selection, experienced operators and surgeons in experienced centers with well-established criteria and processes of care. In this setting, it may be an option for hospitals without institutional cardiac surgery.

Atherosclerosis burden of the aortic valve and aorta and risk of acute kidney injury after transcatheter aortic valve implantation

BackgroundAtheroembolic renal disease, due to dislodgement of cholesterol crystals during maneuvering of a large catheter across the aorta and deployment of the transcatheter prosthesis within a calcified aortic valve, may be one of the pathophysiological mechanisms of acute kidney injury (AKI) complicating transcatheter aortic valve implantation (TAVI). ObjectiveTo investigate the association between the atherosclerotic burden and plaque characteristics of the aortic valve and thoracic aorta, evaluated with multidetector CT (MDCT), and the occurrence of AKI after TAVI. MethodsAortic valve calcification, atherosclerosis burden, and plaque characteristics of the thoracic aorta (including aortic root, ascending aorta, aortic arch, and descending aorta) were analyzed in preprocedural MDCT data of 210 TAVI patients (age, 81 ± 7.1 years; 51.4% men). The thoracic aorta was divided into ascending aorta, aortic arch, and descending thoracic aorta which was further divided into 5 to 8 segments according to the posterior intercostal arteries. Each segment where the maximum wall thickness exceeded ≥2 mm was defined as diseased segment with atherosclerotic plaque. Aortic atherosclerosis burden was defined as the proportion of thoracic aortic segments with atherosclerosis. AKI was defined by a creatinine level ≥1.5 × baseline or ≥26.4 μmol/L above baseline. MDCT data were correlated with the occurrence of postprocedural AKI in a multivariate logistic regression model. ResultsPostprocedural AKI occurred in 51 patients (24.3%). In patients with AKI, the burden of overall (87.5% [75%–90%] vs 71.4% [50%–87.5%]; P < .001) and noncalcified atherosclerosis (42.9% [22.2%–62.5%] vs 12.5% [0%–28.6%]; P < .001) and the maximum plaque thickness (5.7 ± 1.8 mm vs 4.5 ± 1.4 mm; P < .001) were larger compared with patients without AKI. The burden of noncalcified atherosclerosis remained independently associated with AKI (odds ratio, 1.03 [per each 1% of increase in aortic segments with noncalcified atherosclerosis]; 95% confidence interval 1.01–1.05; P = .006) after adjusting for baseline renal function, logistic EuroSCORE, and procedural access. In contrast, aortic valve calcification was not independently associated with AKI. ConclusionIn patients undergoing TAVI, occurrence of postprocedural AKI was associated with the extent of noncalcified atherosclerotic plaque burden of the thoracic aorta.

Risk factors for paravalvular leak after transcatheter aortic valve implantation.

Many studies have shown that transcatheter aortic valve implantation (TAVI) improves outcomes in patients with severe aortic stenosis in whom a classical surgical procedure cannot be performed due to the high risk. As one of the most frequent periprocedural complications of TAVI, paravalvular leak significantly affects the short- and long-term prognosis for patients undergoing implantation. In this paper, we analyze the most significant anatomical and procedural predictors of paravalvular leak after TAVI.

Peripheral embolization of aortic valve calcium following trans-femoral Sapien XT valve implantation requiring emergency surgical embolectomy

Trans-catheter Aortic Valve Implantation (TAVI) is a well-established, alternative, standard of care treatment option for inoperable and high risk patients with severe, symptomatic aortic stenosis (AS) [1]. Peri-procedural cerebrovascular events are a known complication of TAVI and comprise more than half of TAVI related strokes with a 30day incidence of 2–5% [2]. In the acute (<24hours) and sub-acute (1–30day) setting, post-TAVI stroke may be due to embolization of atherosclerotic or calcific material from the aortic valve, the risk of which is increased when valve embolization occurs or post-dilatation is carried out [3].

Valve implantations on the move.

Valve implantations on the move.

Impact of the Use of Transradial Versus Transfemoral Approach as Secondary Access in Transcatheter Aortic Valve Implantation Procedures

No data exist on the impact of vascular complications related to the secondary access site in transcatheter aortic valve implantation (TAVI). The objectives of this nonrandomized study were to determine the rate of vascular complications related to the secondary access site in TAVI procedures and to evaluate the clinical impact of using the radial versus femoral approach as a secondary access in such procedures. A total of 462 consecutive patients (mean age 79 ± 9 years, 50% men) who underwent TAVI were included. The femoral approach (FA) was used as the secondary access (for the insertion of a 5F pigtail catheter) in 335 patients and the radial approach (RA) in 127 patients. Thirty-day events were prospectively collected. There were no baseline differences between groups, except for a higher prevalence of women and peripheral disease in the FA group (p <0.05 for both). A total of 74 vascular access site complications occurred in 70 patients (15%), and 23% of them (29% in the FA group) were related to the secondary access. The use of FA as secondary access was associated with a higher rate of vascular complications (5.0% vs 0% in the RA group, p = 0.005, adjusted p = 0.014). All major vascular complications related to the secondary access occurred in the FA group (3% vs 0% in the RA group, p = 0.040, adjusted p = 0.049), and this translated into a higher rate of major and/or life-threatening bleeding events related to the secondary access in the FA group (3% vs 0% in the RA group, p = 0.040, adjusted p = 0.049). In conclusion, about 1/4 of vascular access site complications in TAVI are related to the secondary access. The use of the RA as a secondary access was associated with a major reduction in vascular complications. These results highlight the impact of secondary access vascular complications in TAVI procedures and support the use of the RA as the preferred secondary access.

Transcatheter aortic valve implantation-induced left bundle branch block: causes and consequences.

Transcatheter aortic valve implantation (TAVI) is an alternative treatment option for patients with severe aortic valve stenosis who do not qualify for surgical aortic valve replacement (AVR). Besides its proven clinical benefits, one of the complications of TAVI is the creation of conduction abnormalities, like left bundle branch block (LBBB). New LBBB occurs between 7 and 65% of cases, numbers that differ considerably between devices. In this review, we discuss the possible causes and the clinical significance of TAVI-induced LBBB. Several device- and procedural-related factors seem responsible for the development of LBBB, of which depth of implantation and balloon-annulus diameter ratio are the most important ones. TAVI-induced LBBB negatively affects cardiac function and hospitalization, but its impact on mortality is subject of debate. Future research and registries should implement strict diagnostic criteria for LBBB together with recording of its timing and persistence.

An Update On Complications Associated With Transcatheter Aortic Valve Implantation: stroke, Paravalvular leak, Atrioventricular Block and Perforation

Transcatheter aortic valve implantation (TAVI) has become an alternative therapeutic option for patients with symptomatic severe aortic stenosis at high surgical risk and the standard of care in patients who are inoperable for open aortic valve replacement. With technological evolution and increasing experience, the procedure has become more predictable. Complications of TAVI, however, are not infrequent, and can range from minor to life-threatening events. Stroke, paravalvular leak, various forms of atrioventricular block, including the need for permanent pacemakers and aortic annular and ventricular perforation will be the focus of the present review. Other complications associated with TAVI (such as vascular injury, acute kidney injury, coronary obstruction, valve malpositioning or migration) are clinically important, but are beyond the scope of this article. Understanding the occurrence and pathophysiology of these complications may provide insights into the improvement of the transcatheter devices and techniques, and aid in extending the application of TAVI to a broader population.

EComment. Aortic thrombus after aortic valve bypass surgery

Conventional aortic valve replacement (AVR) carries significant operative risks, especially in the elderly, high-risk patients with severe aortic valve stenosis including porcelain ascending aorta, complex left ventricular outflow tract obstruction, previous cardiac surgery (patent coronary grafts) or prior sternal infection, and previous radiation to the mediastinum. Transcatheter aortic valve implantation (TAVI) is an alternative therapeutic option in these complicated situations. Nevertheless, TAVI has some limitations in patients with severe aorto-iliac disease, small aortic annulus (<18 mm), and previous prosthetic valve. It is associated with an increased incidence of major stroke, an injury to atrioventricular conduction system, and major vascular complications. Due to a higher incidence of complications of TAVI, aortic valve bypass (AVB, apicoaortic conduit) surgery may be a therapeutic means of choice in high-risk patient populations with comorbidities. We read the article by Lund et al. [1] with great interest. The authors have shared with us their Danish experiences regarding AVB. They are to be commended for reminding us of another alternative in the armamentarium for the treatment of severe aortic stenosis. The authors clearly stated the benefits of AVB. However, there is mention of a few serious complications. We would like to add a short comment concerning the complications of AVB. AVB involves the use of a valved conduit to connect the left ventricular apex to the descending aorta, thereby providing an additional outlet for blood flow and relieving the left ventricular pressure overload. Despite these advantages, there are likely concerns about malperfusion, aortic stasis and the potential for complications concerning the conduit. The potential complications of AVB include bleeding, thromboembolic events, porcine valve deterioration, endocarditis, myocardial infarction, arrhythmias, pseudoaneurysm formation of left ventricular apex graft anastomosis, conduit dehiscence from left ventricular apex, ventricular septal defect as reported by the authors, and thrombus formation in the aorta. Aortic thrombus is a rare moribund complication of AVB and needs to be recognized. There have been some case reports of thrombus formation in the ascending aorta possibly caused by stagnation of native antegrade blood flow and fractionation of the cardiac output [2-5]. Parsa et al. [2] reported catastrophic complication of thrombus in the aortic root after AVB in a patient with severely left ventricular dysfunction, which required a left ventricular assist device. On the contrary, Takeda et al. [3] reported unusual thrombus formation in the aortic arch after AVB for severe aortic stenosis with good left ventricular ejection fraction. Kotani et al. [4], by postoperative cine MRI study, reported that 29% of the cardiac output occurred through the native aortic valve but antegrade flow had decreased to 6% of the cardiac output at one year after surgery. Takahashi et al. [5] described that thrombus formation may be due to flow competition after AVB, especially in cases with poor left ventricular function. Despite these undesired complications, we think that AVB still remains a safe and alternative option for a few high-risk complex patients in whom surgical AVR or TAVI is not feasible. Conflict of interest: none declared.

Coronary Obstruction Following Transcatheter Aortic Valve Implantation: A Systematic Review

This study sought to evaluate, through a systematic review of the published data, the main baseline characteristics, management, and clinical outcomes of patients suffering coronary obstruction as a complication of transcatheter aortic valve implantation (TAVI). Very few data exist on coronary obstruction after TAVI. Studies published between 2002 and 2012, with regard to coronary obstruction as a complication of TAVI, were identified with a systematic electronic search. Only the studies reporting data on the main baseline and procedural characteristics, management of the complication, and clinical outcomes were analyzed. A total of 18 publications describing 24 patients were identified. Most (83%) patients were women, with a mean age of 83 ± 7 years and a mean logistic European System for Cardiac Operative Risk Evaluation score of 25.1 ± 12.0%. Mean left coronary artery (LCA) ostium height and aortic root width were 10.3 ± 1.6 mm and 27.8 ± 2.8 mm, respectively. Most patients (88%) had received a balloon-expandable valve, and coronary obstruction occurred more frequently in the LCA (88%). Percutaneous coronary intervention was attempted in 23 cases (95.8%) and was successful in all but 2 patients (91.3%). At 30-day follow-up, there were no cases of stent thrombosis or repeat revascularization, and the mortality rate was 8.3%. Reported cases of coronary obstruction after TAVI occurred more frequently in women, in patients receiving a balloon-expandable valve, and the LCA was the most commonly involved artery. Percutaneous coronary intervention was a feasible and successful treatment in most cases. Continuous efforts should be made to identify the factors associated with this life-threatening complication to implement the appropriate measures for its prevention.

Potential complications of transcatheter aortic valve implantation (TAVI)—an autopsy perspective

Degenerative or post-endocarditic destruction of aortic valves with secondary left ventricular hypertension and cardiac insufficiency is seen more frequently in patients of increasing age. When conventional aortic valve replacement is no longer an option, because of age and co-morbidity, patients are increasingly treated with interventional aortic valve replacement using transcatheter aortic valve implantation (TAVI). TAVI has been performed in Cologne since 2008. We screened our autopsy registry for cases of TAVI, identifying and characterizing complications in connection with the TAVI procedure. We found 13 patients who underwent TAVI procedure. Five of these patients died of non-TAVI specific postoperative complications, whereas in 8 patients there was a direct relationship between TAVI complications and the cause of death. The Patients died within hours and few days after TAVI procedure respectively. Problems observed included predominantly complications due to calcifications of the aortic valve cusps as well as acute endocarditis in 20% of cases. In one case there was an irreversible compression of the implanted valve due to cardiac resuscitation and a malposition of the bioprosthesis. Future improvements of preoperative evaluation, especially concerning the degree of calcifications of the aortic valve, appear necessary to increase the chance of preventing such complications. Until then, autopsy analysis of complications may help to improve the TAVI procedure.

153: Comparison of primary pacemaker implantations in the following transcatheter aortic valve implantation (TAVI) in the University Hospital of Clermont Ferrand, according to two types of valve

Aortic valve replacement is the definitive therapy for severe aortic stenosis (valve area<0.6cm 2 /m 2 ). Elderly and the associated comorbidity represent an operative risk (estimated with the EuroSCORE). TAVI is an alternative to surgery or balloon valvuloplasty. Two valves were marketed: Edwards and CoreValve. The complications of TAVI are well known and similar for the both. Only the primary pacemaker implantations (PPI) are greater with CoreValves. The objectives are to compare the PPI after a TAVI in the CHU of Clermont Ferrand depending on the type of valve, then to explain this difference. We used the register FRANCE II to a retrospective analysis of all patients with a TAVI in the CHU of Clermont Ferrand. We only excluded patients who died within 24 hours post procedure and patients who were already a pacemaker. The search for a PPI, age, type of valve, diameter of the valve, surgical approach, presence of bundle branch block (BB), operator dependence and learning curve were analyzed. From January 2010 to March 2012, 78 were included in this study (66% of CoreValve and 34% of Edwards). Of the 22 PPI (22.9%), 100% complicated a Corevalve (p=0.00034). Age, operator, learning curve, surgical approach and diameter of the valve are not risk factors for PPI, in contrast to the presence of BB (p=0.025). This study confirms that CoreValves are more complicated PPI than Edwards. The presence of BB is a risk factor for primary implantation. The lack of power of this study does not reveal other risk factors such as the diameter of the valve or the learning curve effect.