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Background: The capacity of TAVI-programs and numbers of sites performing TAVI has rapidly increased. This necessitated the initiation of the Rotterdam TAVI Care & Cure Program, aiming to improve patient-centered care during the TAVI pathway. Methods: Consenting patients with severe aortic stenosis and an indication for TAVI will be included. The TAVI Care & Cure program will facilitate prognostic contributions to improve outcomes, patient satisfaction and quality of life in patients with valvular heart disease who are treated with a transcatheter aortic valve implantation in collaboration with the departments of cardiology, cardio-thoracic surgery, anesthesiology and geriatrics. Conclusion: With a single center observational registry, we aim to assess the TAVI patient clinical pathway, focusing on pre, peri and post interventional variables including functional status and HRQoL. We will evaluate the patient's complexity by applying an extended multidisciplinary approach, which includes a systematic application of geriatric assessments of frailty and cognitive function.

Background: Vascular complications (VCs) after transcatheter aortic valve implantation (TAVI) are associated with impaired outcome. We performed a meta-analysis to determine in-hospital/30-day majo...

Background: Myocardial injury (MI) is common with transcatheter aortic valve implantation (TAVI) and may predict poor outcome. We aim: 1) to evaluate the difference in change of high-sensitivity-Tr...

We sought to evaluate the interaction of different aortic root phenotypes with self-expanding (SEV), balloon-expandable (BEV) and mechanically expanded (MEV) and the impact on significant aortic regurgitation.We included 392 patients with a SEV (N = 205), BEV (N = 107) or MEV (N = 80). Aortic annulus eccentricity index and calcification were measured by multi-slice CT scan. Paravalvular aortic regurgitation was assessed by contrast aortography (primary analysis) and transthoracic echocardiography (secondary analysis). In mildly calcified roots paravalvular regurgitation incidence was similar for all transcatheter heart valves (SEV 8.4%; BEV 9.1%; MEV 2.0% p = 0.27). Conversely, in heavily calcified roots paravalvular regurgitation incidence was significantly higher with SEV (SEV 45.9%; BEV 0.0%; MEV 0.0% p 0.001). When paravalvular regurgitation was assessed by TTE, the overall findings were similar although elliptic aortic roots were associated with more paravalvular regurgitation with SEV (20.5% vs. BEV 4.5% vs. MEV 3.2%; p = 0.009).In heavily calcified aortic roots, significant paravalvular aortic regurgitation is more frequent with SEV than with BEV or MEV, but similar in mildly calcified ones. These findings may support patient-tailored transcatheter heart valve selection.Aortic stenosis; multislice computed tomography; transcatheter aortic valve replacement; paravalvular aortic regurgitation.We sought to evaluate the interaction of different aortic root phenotypes with self-expanding (SEV), balloon-expandable (BEV) and mechanically expanded (MEV) and the impact on significant aortic regurgitation. We included 392 patients with a SEV (N = 205), BEV (N = 107) or MEV (N = 80). Aortic annulus eccentricity index and calcification were measured by multi-slice CT scan. Paravalvular aortic regurgitation was assessed by contrast aortography and transthoracic echocardiography. We found that in heavily calcified aortic roots, significant paravalvular aortic regurgitation is more frequent with SEV than with BEV or MEV, but similar in mildly calcified ones.

Resumen Introduccion y objetivos Se sabe que los factores relacionados con el paciente y con la intervencion se asocian con insuficiencia aortica despues de un implante percutaneo de valvula aortica. No obstante, tambien puede causarla una interaccion especifica entre el dispositivo y el huesped como consecuencia de las propiedades biomecanicas de las valvulas, con independencia de los factores clinicos. El objetivo de este estudio es esclarecer el papel de la geometria de la valvula en la aparicion de insuficiencia aortica despues del implante de las valvulas Medtronic CoreValve® y Edwards SAPIEN®. Metodos Se llevo a cabo un estudio observacional que incluyo a 134 pacientes tratados con implante percutaneo de valvula aortica empleando las valvulas Medtronic CoreValve® y Edwards SAPIEN®. El analisis geometrico se realizo en tres niveles predefinidos de ambas valvulas mediante angiografia rotacional con compensacion de movimiento usando un programa informatico especificamente desarrollado para este fin. Se establecio una distincion entre los pacientes con insuficiencia aortica nula o leve y los pacientes con insuficiencia aortica moderada o grave segun la ecocardiografia. Resultados Las caracteristicas basales eran similares con ambas valvulas. A pesar del mayor uso de predilatacion en el grupo de CoreValve® (el 95,2 frente al 82,0%; p = 0,012), el mayor exceso de tamano de protesis/anillo aortico (perimetro, el 114 ± 7% frente al 103 ± 7%; p Conclusiones Independientemente de los factores relacionados con el paciente y con la intervencion, existe una interaccion entre dispositivo y huesped que es especifica del dispositivo y explica la insuficiencia aortica existente despues de un implante percutaneo de valvula aortica.

OBJECTIVES The aim of this study was to identify variables associated with tissue fragment embolization during transcatheter aortic valve replacement (TAVR). BACKGROUND Brain magnetic resonance imaging and transcranial Doppler studies have revealed that cerebrovascular embolization occurs frequently during TAVR. Embolized material may be r thrombotic, tissue derived, or catheter (foreign material) fragments. METHODS A total of 81 patients underwent TAVR with a dual filter–based embolic protection device (Montage Dual Filter System, Claret Medical, Inc., Santa Rosa, California) deployed in the brachiocephalic trunk and left common carotid artery. Both balloon-expandable and self-expanding transcatheter heart valves (THVs) were used. Filters were retrieved after TAVR and sent for histopathological analysis. RESULTS Overall, debris was captured in 86% of patients. Captured material varied in size from 0.1 to 9.0 mm. Thrombotic material was found in 74% of patients and tissue-derived debris in 63%. Tissue fragments were found more often with balloon-expandable THVs (79% vs. 56%; p ¼ 0.05). The embolized tissue originated from the native aortic valve leaflets, aortic wall, or left ventricular myocardium. On multivariable logistic regression analysis, balloonexpandable THVs (odds ratio: 7.315; 95% confidence interval: 1.398 to 38.289; p ¼ 0.018) and cover index (odds ratio: 1.141; 95% confidence interval: 1.014 to 1.283; p ¼ 0.028) were independent predictors of tissue embolization. CONCLUSIONS Debris is captured with filter-based embolic protection in the vast majority of patients undergoing TAVR. Tissue-derived material is found in 63% of cases and is more frequent with the use of balloon-expandable systems and more oversizing. (J Am Coll Cardiol Intv 2015;8:718–24) © 2015 by the American College of Cardiology Foundation.

Patient-specific computer simulation of transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve morphology has previously been demonstrated to reliably predict the development of both paravalvular regurgitation (PVR) and conduction disturbance. We hypothesised that patient-specific

The efficacy of cerebral embolic protection (CEP) during transcatheter aortic valve replacement (TAVR) is unresolved. We aimed to compare the rates of neurological events and all-cause mortality after TAVR in patients with or without CEP. We studied all patients who underwent transfemoral TAVR with