Medtronic CoreValveTM Research Articles

Rupture of the ascending aorta 6 months after TAVI procedure caused by TAVI prosthesis

BackgroundTranscatheter aortic valve implantation (TAVI) is indicated for elderly patients who often have severe comorbidities and high operative risk. Despite many advantages, it carries the potential for both early and late complications. The literature reports mainly periprocedural problems. This case report describes a rare instance of ascending aortic rupture as a late complication following TAVI.Case presentationAn 81-year-old male with severe aortic stenosis (AS) was a non-surgical patient due to a high operative risk (EuroSCORE II 14.08%) and comorbidities, including cardiovascular problems, chronic obstructive pulmonary disease, myelodysplastic syndrome. During the TAVI procedure Medtronic CoreValve™ Evolut™ R-26 was implanted via the right femoral artery. Postoperative period elapsed without complications and the patient was discharged home. Six months later, the patient was re-admitted to the hospital on an emergency basis and transferred directly to the operating room due to ascending aortic rupture (EuroSCORE II 53.20%, GERAADA score 64.9%). Computed tomography angiography (CTA) showed aortic rupture with a multiple fresh blood reservoirs and thrombus around the ascending aorta originating from the spot where the nitinol frame of the TAVI valve was attached to the native aorta. Supracoronary excision of the ascending aorta with implantation of a vascular graft (Intergard Woven Graft 34 mm) was performed, preserving the earlier implanted TAVI valve. On the 9th day after surgery the patient’s general condition deteriorated, he suffered from circulatory and respiratory insufficiency. Furthermore, a gastrointestinal bleeding with the need for gastro-, and colonoscopy and multiple blood transfusions occurred. Patient developed urosepsis and acute renal failure with the need for hemodiafiltration. Despite intensive treatment, further deterioration of the medical condition of the patient. and finally the multiple organ failure was observed. Patient died on the 50th postoperative day.ConclusionsTAVI is a safe method of treating severe AS, especially recommended for non-surgical candidates. Rupture of the ascending aorta is a rare but serious complication of TAVI that usually occur during or shortly after the procedure. This case report highlights the importance of post-procedural monitoring for such TAVI complications, even in the late period following TAVI, and if such complications occur, taking the risk to perform a life-saving operation.

Valve-in-valve transcatheter aortic valve replacement on a self-expandable nitinol frame due to degeneration of primary bioprosthetic valve cusps. Clinical case of a high-risk surgical female patient

Introduction. We present the clinical observation of a 72-year-old female patient with high surgical risk and structural degeneration of a bioprosthetic aortic valve (AV) cusps in the form of stenosis, accompanied by severe dysfunction. Transcatheter implantation of bioprosthesis Medtronic CoreValve™ Evolut™ R-23 was performed using the valve-in-valve technique. The choice of minimally invasive treatment tactics is substantiated, a preoperative examination algorithm and a specific bioprosthesis model for such intervention are provided. Materials and methods. Imaging – echocardiography (Echo), electrocardiography, multispiral computed tomography, coronary angiography. Bioprosthetic valve calcification and stenosis with critical parameters of the bioprosthetic AV peak pressure gradient according to Echo data were the indications for minimally invasive surgery. Results. Dynamic observation revealed a progressive deterioration in the function of the previously implanted bioprosthetic heart valve in the aortic position, and a critical deterioration in the patient’s condition. After additional examination of the patient and selection of a new prosthesis, valve-in-valve transcatheter aortic valve replacement was done. The positive dynamics of the general state of the patient was noted in the early postoperative period. Echo data showed that the bioprosthetic AV peak systolic pressure gradient decreased from 90 to 29 mmHg, average gradient – from 42 to 19 mmHg. Conclusion. The minimally invasive valve-in-valve transcatheter aortic valve replacement used to correct the dysfunction of a bioprosthetic AV that was previously implanted during an open surgery was shown to be safe and effective and can be considered as one of the options for repeat valve replacement.

Coronary Procedures After TAVI With the Self-Expanding Aortic Bioprosthesis Medtronic CoreValve™, Not an Easy Matter.

To evaluate the feasibility of coronary procedures after transcatheter aortic valve implantation (TAVI) with the CoreValve™ device. Due to its design, CoreValve™ prosthesis may interfere with coronary procedures. Data on this issue are sparse. Between 2007 and 2015, 550 patients underwent CoreValve™ TAVI in our hospital. Among them, 16 underwent coronary angiogram after TAVI and were included in our retrospective study. For each patient, we compared the characteristics of coronary angiograms performed before and after TAVI. Coronary angiogram was deemed successful in 9 patients. The mean number of different catheters used in attempts to cannulate the coronary arteries was 3.6 ± 1.4 and the rate of selective intubation was low. Fluoroscopy time (13.2 ± 5.8 vs. 7.2 ± 4.6 min, P = 0.003), dose area product (5,347 ± 4,919 vs. 3,433 ± 3,420 cGy/m2 , P = 0.004), and contrast volume (157.7 ± 69.6 vs. 108.3 ± 42.6 mL, P = 0.006) were more important in coronary angiograms performed after CoreValve™ implantation. Percutaneous coronary intervention was successfully performed in 6 out of 7 patients who required it. Coronary procedures after CoreValve™ TAVI are feasible, but challenging. This problem is currently rare but will be more common as the indications of TAVI are expanded to younger patients with longer life expectancies. Recommendations for post-TAVI coronary procedures are needed, particularly for centers unfamiliar with the management of post-TAVI patients.

Valve implantations on the move.

Valve implantations on the move.

Antiplatelet therapy following TAVI: time to randomise

Following the introduction of transcatheter aortic valve implantation (TAVI), it is now possible to treat elderly patients with severe aortic stenosis and a high surgical risk. This advancement in interventional cardiology has led to increased survival, health status and quality of life. However, as with many invasive interventional procedures, TAVI is associated with the risk of cerebral embolisation and consequent ischaemic cerebrovascular events with possible neurological impairment. The risk estimates of post-procedural stroke associated with TAVI vary from 1.5 to 10 % and have been reported both early and late after the procedure. In the PARTNER Cohort B study, the Canadian multicentre TAVI registry and the study by Nuis et al., about 50 % of the stroke events occurred more than 24 h post-procedure [1]. In addition to clinically overt stroke, asymptomatic silent cerebral infarcts have been frequently observed on MRI, with a prevalence ranging from 62 to 93 % [2]. Although asymptomatic, accumulating evidence implicates that these silent cerebral infarcts are related to risk of future stroke, cognitive decline, dementia, and depression. Whether stroke occurs due to incomplete endothelialisation of the valve or by new onset of silent atrial fibrillation is unknown. Early post-procedural stroke (<24 h) is more likely the result of embolisation during valve implantation. Given this high incidence of cerebral events, adequate anticoagulation is probably required both during the procedure and in the following months. However, the exact regimen of anticoagulation involves a clinical dilemma with the therapeutic potential of reducing ischaemic complications at the expense of increasing the bleeding risk. The overall incidence of bleeding following TAVI has been reported in 41 % of the patients in the meta-analysis conducted by Genereux et al., of which 16 % were life-threatening [3]. It is important to bear in mind that life-threatening bleeding is associated with a six- to nine-fold increase in 30-day mortality after procedure and acts as an independent predictor of 1-year mortality [4]. Therefore, for clinical decision-making on antithrombotic treatment, it is important to find a balance between prevention of ischaemic complications and avoidance of bleeding risk. The recently published study by Nijenhuis et al. addresses this clinical dilemma regarding decision-making on anticoagulation treatment of elderly patients treated with TAVI [5]. As pointed out by the authors, the current European and American guidelines merely provide recommendations based on retrospective registries. The European Society of Cardiology guidelines recommend a combination of low aspirin and a thienopyridine early after TAVI, followed by aspirin or a thienopyridine alone. In those cases where there is an indication for treatment with vitamin K antagonists, such as in atrial fibrillation, a combined treatment of vitamin K antagonist and aspirin or a thienopyridine is in general installed. However, the guidelines do not provide any recommendations on the duration of dual antiplatelet therapy (DAPT). As observed in the survey undertaken in the Netherlands, a wide heterogeneity in the duration of dual antiplatelet therapy (DAPT) and loading dose of clopidogrel was noted. In two-thirds of the centres (n = 9) DAPT was prescribed for 3 months. In one centre, where only transapical TAVI is performed, no concomitant clopidogrel was prescribed at all. The duration of concomitant clopidogrel was dependent on the type of prosthesis in only two centres according to the recommendations of the respective manufactures, 6 months versus 3 months for supra-annular Core Valve™ and intra-annular prostheses (e.g. SAPIEN™, JenaValve), respectively. Whether the decision on the duration of concomitant clopidogrel and its loading dose indeed should be dependent on the valve type (SAPIEN™ or Medtronic Core Valve™) or procedural approach (transfemoral or apical) has not been described in the literature. Moreover, clinical decision-making becomes more complex in circumstances where there is a high bleeding risk, PCI (<1 year) prior to TAVI, triple therapy pre-TAVI and new-onset atrial fibrillation. This is nicely illustrated in the survey of the participating centres showing different approaches to these scenarios. In conclusion, the appropriate regimen of antiplatelet and anticoagulant therapy following TAVI is undefined and warrants the conduction of randomised controlled trials for clinical decision-making in this steadily growing patient population.

Transcatheter aortic valve implantation (TAVI) in a patient with severe aortic insufficiency of aortic valve homograft

We present the case of a 64-year-old female who was admitted to our centre with severe aortic insufficiency and advanced heart failure symptoms (NYHA class III–IV). Her medical history included: surgical homograft aortic valve replacement due to severe aortic insufficiency 14 years ago, chronic atrial fibrillation, and hypothyroidism. The patient’s logistic EuroSCORE was 32%, EuroSCORE II 9.1%, and STS score 3.95%. Preprocedural transthoracic echocardiographic examination revealed akinesis of the basal and mid segments of interventricular septum, global hypokinesis of remaining segments with ejection fraction of 19%, enlargement of the left ventricle and atrium (diameter of 68 and 43 mm, respectively), regurgitant orifice area of 0.3 cm2, regurgitant volume of 58 mL, and regurgitant jet width to left ventricular outflow tract ratio of 66% (Fig. 1). An additional transoesophageal echocardiographic examination was performed for more precise measurement: this showed aortic annulus diameter of 24 mm. Angiography and computed tomography were also performed, showing no lesions in either the coronary or peripheral arteries. On the basis of the abovementioned clinical conditions, the Heart Team decided to refer the patient to transcatheter aortic valve implantation (TAVI) via femoral access. The procedure was performed under general anaesthesia with a temporary pacemaker placed through the jugular vein and vascular access obtained with 18 Fr sheath by puncture of the right femoral artery. Due to lack of calcifications, two pig-tail catheters were placed in order to mark the plane of the annulus (Fig. 2) and 29 mm Medtronic CoreValveTM bioprosthesis was implanted under rapid pacing. Despite these preventive measures, the final position of prosthesis was too low with moderate-to-severe aortic insufficiency (Fig. 3) that persisted even after postdilatation with a 28 mm balloon. Therefore, the decision to implant another 29 mm CoreValve 10 to 15 mm higher was made. Finally, in control imaging, only a mild paravalvular leak was present (Fig. 4), and on discharge the ejection fraction had improved to 43%. TAVI is an effective treatment option for severe aortic stenosis in inoperable and high-risk patients. However, failure (mostly insufficiency) of a previous homograft aortic valve poses a challenge for any interventional treatment. In selected patients, TAVI can be a feasible alternative for high risk re-operation. TAVI may also be considered in some cases of native aortic insufficiency where there is favourable anatomy.

Sobrevivência a médio prazo e estado funcional de pacientes com estenose valvar aórtica grave submetidos a implante transcateter da válvula aórtica

INTRODUÇÃO: O procedimento de implante transcateter da válvula aórtica (TAVI, do inglês transcatheter aortic valve implantation) representa opção de tratamento em pacientes com estenose valvar aórtica (EA) com risco cirúrgico elevado ou proibitivo. Relatamos nossa experiência usando o sistema autoexpansível Medtronic CoreValve®. MÉTODOS: No período de 2009 a 2013, 51 pacientes consecutivos com EA grave sintomática e risco cirúrgico alto ou proibitivo foram submetidos ao TAVI. Os resultados foram analisados de acordo com os critérios Valve Academic Research Consortium (VARC) -2. RESULTADOS: A média de idades dos pacientes foi 82 ± 6 anos, 49% eram do sexo feminino, 19% diabéticos, 21% tinham insuficiência renal e o EuroSCORE logístico foi 17,4 ± 11,4%. O sucesso do dispositivo foi alcançado em 84,3%. Todos os pacientes tiveram diminuição significativa dos gradientes transaórticos, que foi mantida ao longo do tempo. A internação hospitalar foi de 6 dias (intervalo interquartil: 5-8,8). A mortalidade intra-hospitalar e aos 30 dias foi 7,8% e 9,8%, respectivamente. Implante de marca-passo permanente foi necessário em 32,6% dos casos; acidente cerebrovascular isquêmico ocorreu em 3,9%; e complicações vasculares maiores em 6% dos pacientes. A sobrevivência aos 6 meses e em 1 ano foi 86,3% e 84,4%, respectivamente. A classe funcional NYHA melhorou significativamente após o TAVI e permaneceu baixa no seguimento de médio prazo. CONCLUSÕES: Nesta experiência preliminar, o tratamento de pacientes com EA e risco cirúrgico alto ou proibitivo com TAVI, usando o sistema autoexpansível CoreValve®, foi considerado viável e seguro, e levou à melhoria sustentável dos sintomas cardíacos. Após a superação dos riscos iniciais de morte e de acidente cerebrovascular, o procedimento garantiu um bom resultado clínico, no longo prazo.

Paravalvular aortic regurgitation as the reason for second CoreValve bioprosthesis implantation in a patient with native bicuspid valve

We present the case of a 70-year-old male patient who was admitted to our centre with severe symptomatic aortic stenosis. His medical history included: hypertension, stroke (1998 and 2013) with subsequent left-sided paraparesis and status after traumatic upper right limb amputation in his youth. Patient’s logistic EuroSCORE was 18.1%, EuroSCORE II 5.7% and the Society of Thoracic Surgeons Score 2.7%. Transthoracic echocardiography showed impaired left ventricular ejection fraction of 27%, mean aortic pressure gradient of 70.5 mm Hg, aortic valve area of 0.6 cm2, and peak velocity of 6.3 m/s. For precise aortic annulus measurement, transoesophageal echocardiography (TEE) and a computed tomography scan were performed and revealed a heavily calcified bicuspid valve with mean annulus diameter of 24 mm. Angiography demonstrated a significant lesion in the 3rd segment of right coronary artery (RCA). Due to the high operative risk, the patient was referred by the Heart Team for percutaneous coronary intervention of RCA and transcatheter aortic valve implantation (TAVI) via the femoral route (considering the absence of atherosclerotic lesions in ilio-femoral arteries). Native valve was predilated with a 22 mm Numed balloon catheteter (Fig. 1A). On the basis of pre-procedural imaging, a 29 mm Medtronic CoreValveTM bioprosthesis was implanted at the annulus level. However, control angio and TEE showed low implantation accompanied by significant paravalvular aortic regurgitation (Fig. 1B). Haemodynamic measurement also confirmed a suboptimal effect with low diastolic aortic pressure (DAP) and high left-ventricular end-diastolic pressure (LVEDP) (Fig. 2A). Therefore, the decision was made to implant a second bioprosthesis — another 29 mm CoreValve was placed and deployed 8–10 mm higher than the first one (Fig. 1C). Implantation of the second valve significantly decreased the magnitude of regurgitation from severe to no or mild, both in angiography and pressure recordings (Figs. 1D and 2A, respectively). It has been shown in several observational and randomised trials that even mild paravalvular regurgitation after TAVI is an independent predictor of long-term mortality. It is therefore of crucial importance to diagnose early and minimise the grade of regurgitation by post-dilatation or second valve deployment. This case demonstrates that apart from imaging modalities, direct pressure measurement is an easy, reliable and reproducible method of paravalvular leak detection. Recently, it has been shown in a non-selected population of TAVI procedures that pressure gradient DDAP-LVEDP is a powerful predictor of mortality.

A plea for caution: transcatheter aortic valve implantation using the Medtronic CoreValve™ prosthesis without balloon predilatation

A plea for caution: transcatheter aortic valve implantation using the Medtronic CoreValve™ prosthesis without balloon predilatation

Incidence and predictors of permanent pacemaker implantation following transcatheter aortic valve implantation: Analysis from the german transcatheter aortic valve interventions registry

To determine predictors of permanent pacemaker (PPM) implantation up to 30 days after transcatheter aortic valve implantation (TAVI) in a prospective multicenter registry. Conduction disorders requiring PPM implantation are one of the most common complications seen after TAVI. Knowledge about possible predictors may help to decrease the rate of PPM implantations. In total, 1347 consecutive patients who underwent TAVI in 22 centers were prospectively enrolled in the German transcatheter aortic valve interventions registry. Both Medtronic CoreValve™ and Edwards Sapien™ valves were implanted. Patients with preprocedurally implanted PPM or implantable cardioverter defibrillator were excluded from the analysis (n = 199). Regression analysis of baseline and procedure characteristics of the remaining 1,147 patients was performed. Procedural success was achieved in 97.4% of the cases. The rate for PPM after TAVI was 33.7%. The absence of prior valve surgery, the use of Medtronic CoreValve™ prosthesis and the presence of a porcelain aorta were identified as independent predictors for PPM after TAVI. Mortality at 30 days did not differ between patients with or without PPM necessity (6.0% vs. 8.1%, respectively; HR 0.72; CI (0.45-1.16); P = 0.17). PPM is a common postprocedure requirement after TAVI. The absence of prior valve surgery, the implantation of Medtronic CoreValve™ prosthesis, and the presence of a porcelain aorta were independently associated with PPM after TAVI.

Occlusion of the left main stem: a rare, but life-threatening complication of transcatheter aortic valve implantation with the Medtronic CoreValve™ prosthesis

Occlusion of the left main stem: a rare, but life-threatening complication of transcatheter aortic valve implantation with the Medtronic CoreValve™ prosthesis

Risk Factors for High Grade AV Block post-Trans-Catheter Aortic Valve Implantation (TAVI) Using the Medtronic CoreValve™

Background: High grade AV block (HGAVB) is a known complication of TAVI using the Medtronic CoreValve™. We aimed to identify risk factors for persistent HGAVB following CoreValve™ implantation. Methods: We retrospectively analysed peri-operative characteristics of 61 consecutive patients between November 2008 and March 2012 for predictors of persistent HGAVB. HGAVB was defined as type 2 second-degree AV block, 2:1 AV block, or third-degree AV block. Risk factors were determined with binary logistic regression using the following input variables: age, pre-procedural PR & QRS intervals, valvuloplasty balloon:annulus ratio, device size:annulus ratio and occurrence of any intra-procedural HGAVB. Statistical analysis was performed using the SPSS 20.0 statistical program. Results: Fifty-four patients (mean age 82 ± 5 years, 65% male) were analysed (seven patients with pre-existing pacemakers were excluded). Prior to TAVI, nine patients had first-degree AV block (17%), two had left bundle branch block (4%), four had right bundle branch block (7%), and three had a non-specific intra-ventricular conduction delay (6%). Fourteen patients (26%)developed persistent HGAVB post-CoreValve™ insertion, thirteen of whom survived to pacemaker implantation. In 12/14 the onset of HGAVB was within seven days of the index procedure. Intra-procedural HGAVB was the only significant predictor of persistent HGAVB following TAVI with CoreValve™ (OR 38.9, 95% CI 1.3–153.4, p < 0.05). Conclusion: One in four patients can be expected to develop persistent HGAVB, usually within seven days of CoreValve™ implantation. Intra-procedural HGAVB is a significant predictor of persistent HGAVB and suggests the need for an appropriate period of monitoring.

Medium-Term Survival and Functional Status of Patients with Severe Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation

ABSTRACT Background Transcatheter aortic valve implantation (TAVI) is a treatment option for patients with aortic valve stenosis (AS) and high or prohibitive surgical risk. We report our experience using the Medtronic CoreValve™ self-expending system. Methods From 2009 to 2013, 51 consecutive patients with severe symptomatic AS and high or prohibitive surgical risk were submitted to TAVI. Results were analyzed according to the criteria of the Valve Academic Research Consortium (VARC) –2. Results Mean age was 82 ± 6 years, 49% were female, 19% were diabetic, 21% had renal failure and the logistic EuroScore was 17.4 ± 11.4%. The success rate of the device was 84.3%. All of the patients had a significant decrease of transaortic gradients, which was maintained over time. Hospitalization time was 6 days (interquartile range: 5-8.8). In-hospital mortality at 30 days as 7.8% and 9.8%, respectively. Permanent pacemaker implantation was required in 32.6% of the cases; ischemic stroke was observed in 3.9% and major vascular complications in 6% of the patients. Survival at 6 months and 1 year was 86.3% and 84.4%, respectively. NYHA functional class improved significantly after TAVI and remained low in the medium-term follow-up. Conclusions In this preliminary experience, the treatment of patients with AS and high or prohibitive surgical risk with TAVI, using the CoreValve™ self-expanding system was feasible and safe and led to sustained improvement of cardiac symptoms. After overcoming the initial risks of death and stroke, the procedure guaranteed good long-term clinical outcomes.

Aortic valve calcium load before TAVI: Is it important?

Aortic valve calcium load before TAVI: Is it important?

Transcatheter Aortic Valve Implantation in the Hybrid Catheterisation Laboratory – Navigating into the Future

Transcatheter aortic valve implantation (TAVI) has emerged as a viable treatment option for high-risk patients with symptomatic, senile degenerative aortic stenosis. Since the first TAVI in 2002, the technology has evolved tremendously. With the downsizing of the device delivery catheter profile, vascular access site complications have decreased significantly. Current access routes are transfemoral, subclavian, transapical and transaortic, with most centres preferring a ‘transfemoral-first’ strategy. Other significant complications of TAVI are cerebrovascular events and conduction disturbances with the need for pacemaker implantation. The current TAVI devices with the largest number of implantations and the best evidence are the Medtronic CoreValve™ and the Edwards SAPIEN XT™. Both devices are already in their third generation. Navigation technology, such as the HeartNavigator, has been developed to facilitate the preparation of the procedure and the actual device implantation. The use of hybrid catheterisation labs for performing TAVI is becoming the standard of care due to the significant advantages with regard to safety and hygiene.

AS-086 Transcatheter Aortic Valve Insertion. Can We Afford Not To Be Involved?

Transcatheter aortic valves have been implanted in New Zealand since August 2008 for severe, symptomatic aortic stenosis (AS) in patients considered high risk for traditional surgical valve replacement. The self expanding Medtronic CoreValve™ (CV) and balloon expandable Edwards Sapien™ (EV) valve were used. We describe our experience with cost-effective analysis.

Transcatheter Aortic Valve-in-valve Implantations for Failed Bioprosthetic Heart Valves at the Prince Charles Hospital

Conclusions: Our data suggests that TAVI may be a viable alternative to conventional surgical aortic valve replacement in this high risk cohort of patients. doi:10.1016/j.hlc.2011.05.379 377 Transcatheter Aortic Valve Implantation (TAVI). Can We Afford Not to be Involved? S. Pasupati 1,∗, G. Devlin1, M. Liang1, D. Kelly 1, R. Fisher 1, N. Kejriwal 2, A. El-Gamel 2 1Department of Cardiology, Waikato Hospital, Hamilton, New Zealand 2 Department of Cardiothoracic Surgery, Waikato Hospital, Hamilton, New Zealand Background: Transcatheter aortic valves have been implanted inNewZealand sinceAugust 2008.Wedescribe our experience with cost-effective analysis. Methods: TAVI has been implanted for severe, symptomatic aortic stenosis (AS) in patients considered high risk for traditional surgical valve replacement using Medtronic CoreValveTM (MCV) and Edwards SapienTM (ESV) valve via trans-arterial or trans-apical access. All patients with severe AS over a year period who received surgical aortic valve replacement (SAVR) in our institution were used for cost-effective analysis. This included t t a

Transcatheter aortic valve implantation: first results from a multi-centre real-world registry

Treatment of elderly symptomatic patients with severe aortic stenosis and co-morbidities is challenging. Transcatheter aortic valve interventions [balloon valvuloplasty and transcatheter aortic valve implantation (TAVI)] are evolving as alternative treatment options to surgical valve replacement. We report the first results of the prospective multi-centre German Transcatheter Aortic Valve Interventions-Registry. Between January 2009 and December 2009, a total of 697 patients (81.4 ± 6.3 years, 44.2% males, and logistic EuroScore 20.5 ± 13.2%) underwent TAVI. Pre-operative aortic valve area was 0.6 ± 0.2 cm² with a mean transvalvular gradient of 48.7 ± 17.2 mmHg. Transcatheter aortic valve implantation was performed percutaneously in the majority of patients [666 (95.6%)]. Only 31 (4.4%) procedures were done surgically: 26 (3.7%) transapically and 5 (0.7%) transaortically. The Medtronic CoreValve™ prosthesis was used in 84.4%, whereas the Sapien Edwards™ prosthesis was used in the remaining cases. Technical success was achieved in 98.4% with a post-operative mean transaortic pressure gradient of 5.4 ± 6.2 mmHg. Any residual aortic regurgitation was observed in 72.4% of patients, with a significant aortic insufficiency (≥Grade III) in only 16 patients (2.3%). Complications included pericardial tamponade in 1.8% and stroke in 2.8% of patients. Permanent pacemaker implantation after TAVI became necessary in 39.3% of patients. In-hospital death rate was 8.2%, and the 30-day death rate 12.4%. In this real-world registry of high-risk patients with aortic stenosis, TAVI had a high success rate and was associated with moderate in-hospital complications. However, careful patient selection and continued hospital selection seem crucial to maintain these results.

There are two sides to everything: two case reports on sequelae of rescue interventions to treat complications of transcatheter aortic valve implantation of the Medtronic CoreValve™ prosthesis

There are two sides to everything: two case reports on sequelae of rescue interventions to treat complications of transcatheter aortic valve implantation of the Medtronic CoreValve™ prosthesis

Peri-Procedural Complications and 30 days Outcomes from Transcatheter Aortic Valve Implantation (TAVI) via Transarterial Method Using Both Medtronic CoreValve™ and Edwards Sapien™ Valve at Waikato Hospital, Hamilton, New Zealand

Peri-Procedural Complications and 30 days Outcomes from Transcatheter Aortic Valve Implantation (TAVI) via Transarterial Method Using Both Medtronic CoreValve™ and Edwards Sapien™ Valve at Waikato Hospital, Hamilton, New Zealand