Transfemoral Aortic Valve Implantation Research Articles

Rationale and design of the Edwards SAPIEN-3 periprosthetic leakage evaluation versus Medtronic CoreValve in transfemoral aortic valve implantation (ELECT) trial : Arandomised comparison of balloon-expandable versus self-expanding transcatheter aortic valve prostheses.

Background and objectivesPeriprosthetic aortic regurgitation (PPR) after transcatheter aortic valve implantation (TAVI) remains an important issue associated with impaired long-term outcomes. The current randomised study aims to evaluate potential differences between the balloon-expandable Edwards SAPIEN-3 and the self-expanding Medtronic CoreValve system with the main focus on post-TAVI PPR by means of novel imaging endpoints, and an additional focus on other clinical endpoints.EndpointsThe primary endpoint of this study is quantitative assessment of the severity of post-procedural PPR using cardiac magnetic resonance imaging. Several other novel imaging modalities (X-ray contrast angiography, echocardiography) are used as secondary imaging modalities for the assessment of PPR following TAVI. Secondary objectives of the study include clinical outcomes such as cerebral and kidney injury related to TAVI, and quality of life.Methods and designThe ELECT study is a single-centre, prospective, two-armed randomised controlled trial. For the purpose of this study, 108 consecutive adult patients suitable for transfemoral TAVI will be randomly allocated to receive the SAPIEN-3 (n = 54) or the CoreValve system (n = 54).DiscussionThe ELECT trial is the first randomised controlled trial to quantitatively compare the extent of post-TAVI PPR between the SAPIEN-3 and CoreValve. Furthermore, it will evaluate potential differences between the two prostheses with regard to mid-term clinical outcome and quality of life.

Incidence, Predictors, and Mid-Term Outcomes of Percutaneous Closure Failure After Transfemoral Aortic Valve Implantation Using an Expandable Sheath (from the Optimized Transcatheter Valvular Intervention [OCEAN-TAVI] Registry)

The aim of this study was to evaluate the incidence, predictors, and outcomes of percutaneous closure device (PCD) failure during transfemoral transcatheter aortic valve implantation (TAVI) with an Edwards Sapien-XT prosthesis using an expandable sheath (eSheath). From October 2013 to April 2016, 1,215 patients who underwent TAVI were prospectively enrolled in the Optimized Transcatheter Valvular Intervention (OCEAN-TAVI) registry. Of these, 478 patients underwent transfemoral TAVI with Sapien-XT prosthesis using an eSheath and percutaneous closure with a Perclose ProGlide system. We evaluated the predictors of PCD failure and whether it affected the clinical outcomes. Patients were aged 85years (interquartile range 82 to 88years). PCD failure occurred in 36 patients (8%). Sheath-to-femoral artery ratio (SFAR) (per 1 increase) (odds ratio 5.40, 95% confidence interval 1.28 to 22.92, p= 0.022) predicted PCD failure in a multivariate model. The sensitivity-specificity curves identified an SFAR threshold of 1.03; the area under the curve for SFAR as a predictor of PCD failure was 0.629. The PCD failure group did not have a higher rate of 30-day mortality (0% vs 1%, p= 0.52) or mid-term (365-day) mortality (log-rank test p= 0.85) compared with the PCD success group in the Kaplan-Meier analysis. In conclusion, PCD failures occurred in 8% of the patients and were not associated with 30-day or mid-term mortality rates after percutaneous transfemoral TAVI. The SFAR threshold of 1.03 was useful for predicting PCD failures.

Left ventricular adaptation after TAVI evaluated by conventional and speckle-tracking echocardiography

ObjectiveOur study aimed to evaluate myocardial adaption and outcome after transfemoral aortic valve implantation (TAVI TF) for severe aortic stenosis by LV ejection fraction (LVEF) and speckle tracking analysis. Methods and resultsFrom 168 patients who underwent TAVI TF between 2010 and 2013 in our institution, n=95 with a follow-up period ≥3months were included and grouped (G) according to baseline left ventricular ejection fraction (LVEF; G1: LVEF<40%, G2: 40%–55%, G3: >55%). LV function was evaluated using conventional and speckle-tracking based parameters. Mortality was tracked up to 60months.Aortic valve orifice diameter and mean aortic gradient improved significantly after TAVI. LV dimensions and LVEF remained largely unchanged. Systolic function significantly improved in G1 (LVEF, p<0.001, global longitudinal strain [GLS], p=0.02) but deteriorated in G3 (LVEF, p=0.004, GLS, p=0.03). It did not change in G2. Diastolic function parameters improved significantly only in G3. Changes of LVEF and GLS were also statistically significant between G1 and G3 (LVEF p<0.0001, GLS p=0.004). Patients exhibited a higher survival rate with an LVEF increase >8% than with LVEF deterioration >8% (p=0.04). GLS changes had no significant impact on mortality. ConclusionIn patient with aortic stenosis and LVEF impairment at baseline, TAVI results in an improved LVEF, while patients with a high LVEF at baseline experience a normalization of LVEF after TAVI. Independent of the baseline value, a deterioration of LVEF leads to a significant increase in mortality.

PMD12 - Cost-Effectiveness of Transfemoral Aortic Valve Implantation Compared with Surgical Aortic Valve and Medical Management in Patients with Severe Symptomatic Aortic Stenosis in Australia

Transcatheter aortic valve implantation (TAVI) has emerged as an alternative for treating aortic stenosis, particularly in patients who are poor candidates for surgical aortic valve replacement. In Australia, TAVI is not yet subsidised on the Medicare Benefits Schedule. The purpose of this study was to assess the cost-effectiveness of transfemoral aortic valve replacement interventions (TAVI-TF) compared with surgical aortic valve replacement and with medical management in patients with symptomatic severe aortic valve stenosis from an Australian healthcare provider perspective. We constructed a Markov model-based probabilistic cost-effectiveness analysis and compared TAVI-TF with surgical aortic valve replacement and with medical management, in terms of lifetime costs, quality-adjusted life years, and cost-effectiveness. The model considered two patient populations: high surgical risk patients and inoperable patients. Overall survival was based on the 5-year published data of the PARTNER trial. Costs were estimated using published data and included the cost of the intervention, index hospitalization, adverse events, follow-up care, and end-of-life care. Utilities were derived from the published PARTNER studies. A 5% discount rate was used for both costs and health outcomes. Deterministic and probabilistic sensitivity analysis was performed to explore uncertainties around assumptions and model input parameters. In the base case, if TAVI-TF is available, the cost per quality-adjusted life year gained is $55,843 in the high-risk cohort and $1,392 for the inoperable cohort. The economic model is most sensitive to the cost of index hospitalization and the cost of the valve system. Transfemoral TAVI compared with surgical aortic valve replacement is cost-effective in Australia if the price of the device is lower. Transfemoral TAVI compared with medical management is cost-effective in Australia for inoperable patients. The sensitivity analyses provided enable decision makers in other countries with similar health care practices to Australia to determine the acceptability of cost-effectiveness ratios according to their willingness-to-pay thresholds.

TCT-227 Apixaban in patients with atrial fibrillation after transfemoral aortic valve implantation compared with vitamin K antagonist

About half of patients undergoing transfemoral aortic valve implantation (TAVI) suffer from atrial fibrillation. Non-vitamin K antagonist oral anticoagulants have not been systematically used in patients after TAVI with atrial fibrillation. We enrolled 617 patients undergoing transfemoral aortic

TCT-360 Impact of suture mediated femoral access site closure with the Prostar XL compared to the ProGlide system on outcome in transfemoral aortic valve implantation

TCT-360 Impact of suture mediated femoral access site closure with the Prostar XL compared to the ProGlide system on outcome in transfemoral aortic valve implantation

Feasibility and outcomes of interventional treatment for vascular access site complications following transfemoral aortic valve implantation.

Despite the completion of more than 60,000 transcutaneous aortic valve implantations (TAVI) per year and an approximately 10-15% incidence of vascular access site complications (VAC), there is a paucity of data on the efficacy and safety of percutaneous VAC treatment. Percutaneous endovascular treatment will be an effective treatment of VAC and associated with a low rate of surgical repair. Despite stent placement in proximity to the hip joint, endovascular treatment will be only rarely associated with disabling symptoms or complications. We conducted a retrospective database analysis including 355 patients who underwent TAVI from January 2011 to October 2015. To facilitate the detection of secondary complications of interventional VAC repair, we conducted structured telephone interviews with a focus on new diagnoses or symptoms of peripheral artery disease. Only four patients (1.1%) required surgical treatment for VAC. Percutaneous balloon angioplasty (PTA) or stent implantation was required for VAC in 44 patients (12.4%). The technical success rate of percutaneous VAC treatment was 93%. Four patients died within 30days of VAC treatment, but only one fatality was directly attributable to VAC. Post procedure mean hospital stay was numerically prolonged by 2.4days in the VAC treatment group (P=0.06). During a median follow-up of 385days (range 89-909days) none of the patients were diagnosed with a late VAC or reported a new diagnosis or symptoms of perfusion deficit or peripheral artery disease. Percutaneous treatment of VAC during TAVI is safe and effectively helps to minimize the need for surgery in the vast majority of VAC. During short- and mid-term follow-up, percutaneous VAC management is associated with low complication rates and good clinical outcomes.

The balloon-expandable Edwards Sapien 3 valve is superior to the self-expanding Medtronic CoreValve in patients with severe aortic stenosis undergoing transfemoral aortic valve implantation

BackgroundResidual paravalvular moderate or severe aortic regurgitation (AR) has been an independent risk factor for mortality after transcatheter aortic valve implantation (TAVI). The design of the third generation Edwards Sapien 3 (ES3; Edwards Lifesciences, Irvine, CA, USA) valve was optimized with an outer skirt to address the issue of paravalvular AR. Methods and resultsWe compared 100 consecutive patients treated with the ES3 for severe aortic stenosis with 100 patients treated with the Medtronic CoreValve (CV; Medtronic, Minneapolis, MN, USA) (Clinical Trial Registration: NCT02162069). We evaluated post-procedural AR, rate of permanent pacemaker implantation, device success, and 30-day clinical outcome according to the criteria of the Second Valve Academic Research Consortium (VARC-2). Frequency of post-procedural moderate or severe AR was significantly lower with ES3 compared to CV (0% vs. 20%, p<0.01), none or trace AR significantly higher with ES3 (69% vs. 38%, p<0.01) as well as device success (97% vs. 73%, p<0.01). There was a significantly lower need for permanent pacemaker implantation with ES3 compared with CV (14% vs. 31%, p<0.01). Cardiovascular mortality at 30 days was significantly lower with ES3 (0% vs. 6%, p=0.01), and the combined endpoint “early safety” was met significantly less with ES3 (10% vs. 21% with CV, p=0.03). ConclusionsTransfemoral TAVI with the ES3 compared with the CV was associated with a significantly lower rate of moderate or severe AR, significantly lower need for pacemaker implantation, and a significantly higher rate of device success according to VARC-2.

Impact of suture mediated femoral access site closure with the Prostar XL compared to the ProGlide system on outcome in transfemoral aortic valve implantation

BackgroundManagement of femoral access site is an important issue in transfemoral transcatheter aortic valve implantation (TAVI) and crucial for acute and long-term outcome. Data on vascular closure devices in this setting are limited. We evaluated safety and efficacy of the Prostar XL compared to the ProGlide suture-based vascular closure device. Methods and resultsWe enrolled 585 patients undergoing percutaneous transfemoral transcatheter aortic valve implantation (TAVI). Outcomes were defined according to Valve academic research consortium (VARC)-2 criteria. In 237 (40.5%) patients femoral access site closure was performed using the Prostar and in 348 patients (59.6%) using the ProGlide vascular closure device. There was no significant difference in patient baseline characteristics including single and dual antiplatelet therapies. Sheath outer diameter was significantly larger in the ProGlide compared with the Prostar group (7.7±1.5 vs. 7.9±0.5mm; p=0.001). Closure device failure according to VARC-2 criteria was significantly more frequent with the Prostar versus ProGlide device (19% vs. 4.6%; p<0.01). Need for surgical repair (11.8% vs. 0%, p<0.01), major (12.2% vs. 2.3%, p<0.01) and minor (17.3% vs. 5.7%, p<0.01) vascular complications and bleeding complications (5.5% vs. 2.0%, p=0.02) occurred significantly more often with the Prostar device compared with the ProGlide system. In addition, in-hospital mortality was higher with Prostar compared with ProGlide (5.9% vs. 2.0%; p=0.01). ConclusionFemoral access site closure with the ProGlide device compared with the Prostar device in transfemoral aortic valve implantation was associated with significantly lower rates of closure device failure, minor and major bleedings and a significantly lower in-hospital mortality.Clinical Trial Registration:clinicaltrials.govNCT02162069.

Lethal heparin-induced thrombocytopenia after transfemoral aortic valve implantation

Lethal heparin-induced thrombocytopenia after transfemoral aortic valve implantation

Is ECG triggering for motion artefact reduction in dual-source CT angiography of the ascending aorta still required with high-pitch scanning? The role of ECG-gating in high-pitch dual-source CT of the ascending aorta.

To compare electrocardiographic (ECG)-triggered high-pitch (HP) dual-source CT angiography (CTA) with non-ECG-triggered HP CTA of the aorta, particularly the ascending aorta, with regard to image quality, motion artefacts, contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR) and radiation dose. 59 consecutive patients who had been referred for CTA for known or suspected aortic disease, previous aortic intervention or planned transapical or transfemoral aortic valve implantation were prospectively included. Patients underwent CTAs with HP, using a dual-source CTA system, with [control group (Group A); n = 30] or without (Group B; n = 29) ECG triggering after randomization. For evaluation, image quality and a motion artefact score (MAS) were assessed in a blinded fashion at different predefined anatomic regions. CNR and SNR were measured at the same levels. Radiation dose estimates and contrast enhancement were compared between the two groups. There were no significant differences for image quality and MAS. The intra-arterial contrast resolution was significantly higher at the level of the aortic arch and descending aorta in the non-triggered group (CNR values, p = 0.002-0.018). No significant differences in the radiation dose were found. Non-triggered HP dual-source CTA provided comparable results with regard to image quality, MAS, CNR, SNR and radiation doses compared with ECG-triggered HP CTA. Therefore, ECG triggering of the ascending aorta might be obviated when HP scanning is available. HP dual-source CTA might obviate ECG triggering in the ascending aorta. Non-triggered HP CTA of the ascending aorta provides an excellent image quality.

OP-072 Comparison of Surgical Approach and Proglide Vascular Closure Devices for Access Site Closure After transfemoral Aortic Valve Implantation

OP-072 Comparison of Surgical Approach and Proglide Vascular Closure Devices for Access Site Closure After transfemoral Aortic Valve Implantation

Puncture Versus Surgical Cutdown Complications of Transfemoral Aortic Valve Implantation (from the Spanish TAVI Registry)

Vascular complications in transcatheter aortic valve implantation using transfemoral approach are related to higher mortality. Complete percutaneous approach is currently the preferred technique for vascular access. However, some centers still perform surgical cutdown. Our purpose was to determine complications related to vascular access techniquein the population of the Spanish TAVI National Registry. From January 2010 to July 2015, 3,046 patients were included in this Registry. Of them, 2,465 underwent transfemoral approach and were treated with either surgical cutdown and closure (cutdown group, n= 632) or percutaneous approach (puncture group, n= 1,833). Valve Academic Research Consortium-2 definitions were used to assess vascular and bleeding complications. Propensity matching resulted in 615 matched pairs. Overall, 30-day vascular complications were significantly higher in the puncture group (109 [18%] vs 42 [6.9%]; relative risk [RR] 2.60; 95% confidence interval [CI] 1.85 to 3.64, p <0.001) due mostly by minor vascularevents (89 [15%] vs 25 [4.1%], RR 3.56, 95% CI 2.32 to 5.47, p <0.001). Bleeding rates werelower in the puncture group (18 [3%] vs 40 [6.6%], RR 0.45, 95% CI 0.26 to 0.78, p= 0.003) mainly driven by major bleeding (9 [1.5%] vs 21 [3.4%], RR 0.43, 95% CI 0.20 to 0.93, p= 0.03). At a mean follow-up of 323days, complication rates remained significantly different between groups (minor vascular complications 90 [15%] vs 31 [5.1%], hazard ratio 2.99, 95% CI 1.99 to 4.50, p <0.001 and major bleeding 10 [1.6%] vs 21 [3.4%], hazard ratio 0.47, 95% CI 0.22 to 1.0, p= 0.04, puncture versus cutdown group, respectively). In conclusion, percutaneous approach yielded higher rates of minor vascular complications but lower rates of major bleeding compared with the surgical cutdown, both at 30-day and at mid-term follow-up in our population.

Use of VeriQ system in transfemoral aortic valve implantation. A novel technique

BackgroundThe use of Doppler/Ultrasound is well documented in Cardiac, Vascular and Transplant surgery. It accurately detects the flow of blood through a vessel, allowing for informed decision making regarding cannulation site, graft anastomosis and assessment of graft patency. Trans-catheter Aortic Valve implantation (TAVI) has recently emerged as an effective treatment of elderly or high risk patients with aortic stenosis. The transfemoral TAVI is the most frequently adopted strategy. However, many patients referred for transfemoral TAVI present some degree of peripheral vascular disease and this is partially responsible for an increased rate of vascular complications. MethodsWe present our experience in 50 patients who were referred for transfemoral TAVI at Oxford heart centre to confirm the point of access for insertion of the femoral sheath and the quality of the femoral artery repair after direct repair. ResultsWe present our experience with High risk cases with aortic stenosis. They have been accepted for transfemoral TAVI. In order to confirm the point of access for insertion of the femoral sheath and Quality of repair, we used VeriQ system as standard procedure. ConclusionThe use of VeriQ system is safe and reproducible method to assess the Point of access for insertion of femoral sheath and the quality of the femoral artery after direct repair in transfemoral TAVI.

IMPACT OF CLOSURE DEVICES IN TAVI PROCEDURES ON VASCULAR COMPLICATIONS AND MORTALITY

The study was intended to evaluate the impact of closure devices on vascular complication and mortality in transfemoral aortic valve implantation (TAVI TF). Between 2009 and 2014, 398 patients (pts.) underwent TAVI TF using two different closure devices, Prostar XL (n=215) and Perclose-Proglide (n=

0017 : Local versus general anesthesia for transfemoral aortic valve implantation: efficiency, safety, prognosis

Transcatheter aortic valve replacement (TAVR) is quickly spreading as an efficient and safe therapy for the treatment of aortic valve stenosis in patients denied for surgery. There is no clear guideline established regarding anesthetic modalities to perform TAVR procedures. This study was designed to assess the superiority of the local anesthesia for transfemoral TAVR, regarding major adverse events occuring in the early postoperative time. From January 2014 to June 2015, 236 consecutive patients were included in the study (99 under general anesthesia [GA] and 137 under local anesthesia [LA]). The primary endpoint was a combination of MACE, rehospitalization for heart failure, acute kidney injury (AKI) stage 2 or 3, lifethreatening bleeding, major vascular complication, cardiac or rythmologic reintervention and/or haemodynamic instability, in the first 30 days after TAVR (each defined by VARC-2 criteria). Baseline characteristics were similar between the two groups. Conversion to general anesthesia occured in only 2 cases and procedural success was 94.9% (p=NS). The combined endpoint was reached in 45 GA patients and in 41 LA patients (p=0.02). We observed significantly less AKIevents in LA patients (9 vs 22; p<0.001), less rehospitalization (0 vs 4; p=0.02) and less vascular access site complications (15 vs 29; p<0.001). Postoperative echocardiographic results were similar in both groups. Secondary analysis revealed a shorter hospital stay (9±6.2 days vs 11.4±6.1 days; p=0.003) and shorter ICU stay (2.2±3.9 days vs 3.4±3.6 days; p=0.016) in LA patients.Fig. 1 Local anesthesia significantly reduced the incidence of major adverse events after transfemoral TAVR, especially AKI and vascular access site complications (main predictors of early death after TAVR), without any significant change in echocardiographic results or procedural success. The author hereby declares no conflict of interestDownload : Download full-size imagePrimary endpoint and echocardiographic results Primary endpoint and echocardiographic results

Impact of New-generation Hybrid Imaging Technology on Radiation Dose during Percutaneous Coronary Interventions and Trans-femoral Aortic Valve Implantations: A comparison with conventional flat-plate angiography

Technological advancements in newer-generation catheterisation laboratories may reduce patient and occupational radiation exposure. We compared fluoroscopy time and dose-area product (DAP) between a Philips Allura X-PER FD20 and Siemens Artis Zeego Hybrid systems for 47 single-vessel percutaneous coronary interventions (PCI) and 35 transcatheter aortic valve implantations (21 Corevalve, 14 Edwards Sapien TAVI) using the FD20, versus 30 PCI and 28 TAVI (15 Corevalve, 13 Sapien) with the Zeego over a 24-month period. Multivariate analysis revealed that, adjusting for patient weight and fluoroscopy time, DAP (median, interquartile range) was 26% lower for PCI with the Zeego than the FD20 [55.6 (27.0-91.5) vs 77.6 (51.2-129.1) Gy.cm(2), P=0.03)] and using tomographic imaging with the Zeego did not increase DAP for TAVI procedures [98.1 (65.9-136.6) vs 112.4 (64.9-156.2) Gy.cm(2) (P=NS). Although fluoroscopy times were longer for TAVI procedures than PCI with both systems (23.5-24.4 vs 7.3-9.2mins, p<0.0001), there was a significant difference in DAP between PCI and combined TAVI with the Zeego (55.6 vs 112.4Gy.cm(2), P<0.006) but not with the FD20 (77.6 vs 98.1Gy.cm(2), P=NS). Specific dose-reducing features of the new-generation system reduced DAP more for PCI than TAVI, as valve replacement procedures use additional cine-acquisition not necessary for PCI.

CRT-400.26 Transfemoral Aortic Valve Implantation in Patients With Symptomatic Severe Aortic Stenosis With the Repositionable Lotus Valve: Results From a High Volume Center

The Lotus valve (Boston Scientific Corporation) is designed to reduce the risk for residual paravalvular aortic regurgitation and can be easily repositioned. The study evaluates the procedural and 30-day results for the 23, 25 and 27mm Lotus valve in patients undergoing transfemoral aortic valve

Abstract 12281: Outcomes in Patients Treated With Transfemoral Aortic Valve Implantation After Admission to the Intensive Care Unit

Introduction: Transcatheter aortic valve implantation (TAVI) has become established as a treatment option for patients with severe symptomatic aortic valve stenosis. Postoperative treatment of these old patients presents a new challenge for intensive care specialists. Although numerous studies have addressed perioperative anesthetic management, little is known about risk factors that lead to a longer intensive care unit (ICU) stay. Hypothesis: We retrospectively analyzed data focusing on the risk factors and indications for a prolonged ICU stay and their outcomes. We also compared predictive value of the SAPS II and EuroSCORE risk evaluation scales. Methods: From 2006 to 2012 a total of 214 consecutive patients (age: 80 ± 6 years) were admitted to the ICU after transfemoral TAVI. Results: Total 30-day mortality was 7%. Non-survivors differed from survivors in the rates of catecholamine therapy on ICU admission (93 vs. 29%; p&lt;0.001), stroke (20 vs. 1%; p&lt;0.001), and sepsis (27 vs. 2%; p&lt;0.001). Acute kidney injury (83 vs. 56%; p &lt; 0.001) and catecholamine therapy (88 vs. 61%; p &lt; 0.001) significantly influenced 2-year survival. Mean SAPS II score was higher in non-survivors (38.1 ± 7.0 vs. 29.9 ± 6.2; p &lt; 0.001), giving a predicted mortality of 23.1 ± 11.7% and 10.5 ± 8.2%, respectively, whereas the logistic EuroSCORE was not able to discriminate between the groups (p = 0.555) (figure 1). Among the biochemical parameters, the maximum values of creatinine (2.46±1.24 vs. 1.77±1.16 mg/dL; p &lt;0.05), procalcitonin (1.44 ± 1.84 vs. 0.51 ± 1.65 ng/mL; p &lt; 0.05), and troponin I (4.46 ± 4.19 vs. 2.02 ± 2.25 ng/mL; p &lt; 0.001) during ICU admission were significantly higher in non-survivors. Conclusions: The SAPS II score was superior to the EuroSCORE in predicting ICU mortality and could be used for post-interventional risk stratification while distinct TAVI risk scores are lacking. Creatinine, procalcitonin, and troponin are strong predictors of 30-day and 2-year mortality after TAVI.

Abstract 19135: Impact of New Cardiac Conduction Disturbances After TAVI on Myocardial Contractility and Mortality

Introduction: Our study aimed to evaluate the impact of procedure-related cardiac conduction disturbances (CCD) on myocardial performance (standard and speckle-tracking-based LV function parameters) after transfemoral aortic valve implantation (TAVI TF). Hypothesis: New cardiac conduction disturbances after TAVI impair LV function and morphology as well as survival. Methods: Between 2010 and 2013, 168 patients (pts.) underwent TAVI TF using the Core Valve at our institution. 95 of them with complete follow-up (mean follow up 264± 241 days) were evaluated with respect to the presence of new CCD and their effect on myocardial performance. Results: Aortic valve orifice and mean gradient significantly improved (from 0.7 ± 0.2 to 1.8 ± 0.4 cm 2 , p&lt;0.001 and from 42.4 ± 17.7 to 8.3 ± 4.0 mmHg, p&lt;0.001, respectively). After TAVI, 37.9% of pts. presented with new CCDs. Pts. without additional CCDs showed an improvement of left ventricular systolic and diastolic function (LVEF from 43.7 ± 16.5% to 48 ± 16.2%, p= 0.004; E/A-ratio from 1.4 ± 1.0 to 1.0 ± 0.9, p= 0.006), whereas pts. with procedure-related CCDs had a mild LVEF deterioration (from 51.8 ± 13.9% to 47.3 ± 8.5%, p=0.16). Comparison of the changes between groups without and with CCDs revealed significant differences (Table 1). However, on Kaplan Meier analysis survival was not significantly different between both groups (p=0.73). Conclusions: Procedure-related conductions abnormalities after TAVI impair LV function, however in our pt. cohort with no impact on overall survival.