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Banga A, Bansal V, Pattnaik H, Amal T, Agarwal A, Guru PK. Extracorporeal Membrane Oxygenation-Supported Patient Outcome Undergoing Transcatheter Aortic Valve Replacement. ASAIO J 2024:00002480-990000000-00548. [PMID: 39213414 DOI: 10.1097/mat.0000000000002305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
The efficacy and safety of extracorporeal membrane oxygenation (ECMO) support during transcatheter aortic valve replacement (TAVR) remains unknown. We conducted a meta-analysis to compare benefit and risk of ECMO in TAVR patients. Bibliographic databases were searched from inception to January 1, 2024. Included studies involved patients ≥18 years old undergoing TAVR and using ECMO emergently or prophylactically. Mortality and procedure success were primary outcomes. Peri- or postoperative complications were the secondary outcomes. We identified 11 observational studies, including 2,275 participants (415 ECMO and 1,860 non-ECMO). The unadjusted mortality risk in ECMO-supported patient was higher than non-ECMO patients (odds ratio [OR] 1.73). The mortality unadjusted risk remained high (OR 3.89) and statistically significant for prophylactic ECMO. Prophylactic ECMO had lower mortality risk compared with emergent ECMO (OR 0.17). Extracorporeal membrane oxygenation-supported patients had lower procedural success rate (OR 0.10). Extracorporeal membrane oxygenation patients undergoing TAVR had significantly increased risk of bleeding (OR 3.32), renal failure (OR 2.38), postoperative myocardial infarction (OR 1.89), and stroke (OR 2.32) compared with non-ECMO patients. Clinical results are not improved by ECMO support in patients with high-risk TAVR. Prophylactic ECMO outperforms emergent. Overall, ECMO support increases mortality and postoperative complications. Transcatheter aortic valve replacement outcomes may improve with prophylactic ECMO in high-risk situations.
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Affiliation(s)
- Akshat Banga
- From the Department of Medicine, Mount Auburn Hospital, Cambridge, MA
| | - Vikas Bansal
- Department of Critical Care Medicine, Mayo Clinic Rochester, MN
| | - Harsha Pattnaik
- Department of Medicine, Lady Hardinge Medical College, University of Delhi
| | - Tanya Amal
- Department of Internal Medicine, William Beaumont University Hospital, Royal Oak, MI
| | - Anjali Agarwal
- Department of Critical Care Medicine, Mayo Clinic Florida, Jacksonville, FL
| | - Pramod K Guru
- Department of Critical Care Medicine, Mayo Clinic Florida, Jacksonville, FL
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Maier RK, Menon D, Stafinski T. The Medical Devices Special Access Program in Canada: A Scoping Study. ACTA ACUST UNITED AC 2018; 13:40-57. [PMID: 29595436 PMCID: PMC5863869 DOI: 10.12927/hcpol.2018.25398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
New health technologies enter Canadian healthcare organizations in various ways, and understanding them is essential to the development of a pan-Canadian Health Technology Management (HTM) Strategy, now a priority of governments across Canada. One way is through Health Canada's Medical Devices Special Access Program (MDSAP), which permits unlicensed devices to be obtained by healthcare professionals. However, the circumstances around and implications of the current use of this program are not clear. A scoping literature review was conducted to clarify these and identify important roles and issues related to the MDSAP. Limited information was found on the MDSAP. Nevertheless, three themes demonstrating the roles of the MDSAP in HTM emerged: arbiter in technology selection, a route to technology procurement and facilitator of health technology innovation. No information suggesting that MDSAP is used to circumvent licensing was found. Rather, it enables desired patient outcomes and product commercialization.
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Affiliation(s)
- Roland K Maier
- Graduate Student, School of Public Health, University of Alberta, Edmonton, AB
| | - Devidas Menon
- Professor, Health Technology and Policy Unit, School of Public Health, University of Alberta, Edmonton, AB
| | - Tania Stafinski
- Director, Health Technology and Policy Unit, School of Public Health, University of Alberta, Edmonton, AB
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Takahashi M, Badenco N, Monteau J, Gandjbakhch E, Extramiana F, Urena M, Karam N, Marijon E, Algalarrondo V, Teiger E, Lellouche N. Impact of pacemaker mode in patients with atrioventricular conduction disturbance after trans‐catheter aortic valve implantation. Catheter Cardiovasc Interv 2018. [DOI: 10.1002/ccd.27594] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Masao Takahashi
- University Hospital Henri Mondor, Department of Cardiology, 51 Avenue du Maréchal de Lattre de TassignyCréteil94000 France
| | - Nicolas Badenco
- University Hospital Pitié‐Salpetrière, Cardiology Unit, 47‐83 bd de l'hôpitalParis75013 France
| | - Jacques Monteau
- University Hospital Henri Mondor, Department of Cardiology, 51 Avenue du Maréchal de Lattre de TassignyCréteil94000 France
| | - Estelle Gandjbakhch
- University Hospital Pitié‐Salpetrière, Cardiology Unit, 47‐83 bd de l'hôpitalParis75013 France
| | - Fabrice Extramiana
- University Hospital Bichat, Cardiology Unit, 46 Rue Henri HuchardParis75018 France
| | - Marina Urena
- University Hospital Bichat, Cardiology Unit, 46 Rue Henri HuchardParis75018 France
| | - Nicole Karam
- Cardiology DepartmentEuropean Hospital Georges Pompidou, 20 Rue LeblancParis75015 France
| | - Eloi Marijon
- Cardiology DepartmentEuropean Hospital Georges Pompidou, 20 Rue LeblancParis75015 France
| | - Vincent Algalarrondo
- University Hospital Antoine‐Béclère, Cardiology Unit, 157 Rue de la Porte de TrivauxClamart92140 France
| | - Emmanuel Teiger
- University Hospital Henri Mondor, Department of Cardiology, 51 Avenue du Maréchal de Lattre de TassignyCréteil94000 France
| | - Nicolas Lellouche
- University Hospital Henri Mondor, Department of Cardiology, 51 Avenue du Maréchal de Lattre de TassignyCréteil94000 France
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Chaudhry MA, Sardar MR. Vascular complications of transcatheter aortic valve replacement: A concise literature review. World J Cardiol 2017; 9:574-582. [PMID: 28824787 PMCID: PMC5545141 DOI: 10.4330/wjc.v9.i7.574] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/25/2017] [Accepted: 05/15/2017] [Indexed: 02/06/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is a relatively newer therapeutic modality which offers a promising alternative to surgical aortic valve replacement for patients with prohibitive, high and intermediate surgical risk. The increasing trend to pursue TAVR in these patients has also led to growing awareness of the associated potential vascular complications. The significant impact of these complications on eventual clinical outcome and mortality makes prompt recognition and timely management a critical factor in TAVR patients. We hereby present a concise review with emphasis on diverse vascular complications associated with TAVR and their effective management to improve overall clinical outcomes.
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Makdisi G, Makdisi PB, Wang IW. Use of extracorporeal membranous oxygenator in transcatheter aortic valve replacement. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:306. [PMID: 27668226 DOI: 10.21037/atm.2016.08.14] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The superiority of transcatheter aortic valve replacement (TAVR) compared with medical therapy for patients with aortic stenosis (AS) who are not suitable candidates for surgery had been proven. Cardiopulmonary bypass (CPB) is rarely used in TAVR. Reports of early use of extracorporeal membranous oxygenator (ECMO) have promising outcomes. ECMO offers the option of cardiac support rescue in case of intraoperative hemodynamic instability and can be instituted in advance when hemodynamic instability is expected. Here we review the English literature about the use of ECMO in TAVR procedures, and discuss the indications and rationale for its use as well as its advantages.
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Affiliation(s)
- George Makdisi
- Gulf Coast Cardiothoracic Surgery Institute, Tampa General Hospital, Tampa, FL, USA
| | - Peter B Makdisi
- Division of Gynecologic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - I-Wen Wang
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indiana University Health, Methodist Hospital, Indianapolis, IN, USA
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Kim CA, Rasania SP, Afilalo J, Popma JJ, Lipsitz LA, Kim DH. Functional status and quality of life after transcatheter aortic valve replacement: a systematic review. Ann Intern Med 2014; 160:243-54. [PMID: 24727842 PMCID: PMC4039034 DOI: 10.7326/m13-1316] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The functional and quality-of-life benefits of transcatheter aortic valve replacement (TAVR) have not been established. PURPOSE To evaluate the changes in functional status and quality of life after TAVR. DATA SOURCES MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from 1 January 2002 to 30 September 2013. STUDY SELECTION Studies of TAVR that reported the New York Heart Association (NYHA) class, Short Form-12/36 Health Survey physical and mental component summary (points), or other measures of functional status. DATA EXTRACTION Two reviewers independently extracted the mean change (follow-up minus baseline) in primary outcomes. Because of substantial heterogeneity, data were not pooled; the range of mean change was summarized. DATA SYNTHESIS We identified 60 observational studies (56 pre–post comparison and 4 head-to-head comparative studies) and 2 randomized, controlled trials (11 205 patients). Most studies showed a clinically important decrease in NYHA class at 6 to 11 months (range, -0.8 to -2.1 classes) and 12 to 23 months (range, -0.8 to -2.1 classes). The improvement in the Short Form-12/36 Health Survey physical component score was clinically important over 12 months (range, 4.9 to 26.9 points), and the change in mental component score was smaller (range, 1.0 to 8.9 points).Clinically important improvements were seen in other disease-specific measures but were less consistently seen in general health measures. LIMITATIONS Comparative evidence is limited by few head-to-head studies. Survivor bias may have overestimated the benefits. CONCLUSION Transcatheter aortic valve replacement provides clinically important benefits in physical function and disease-specific measures of quality of life but modest benefits in psychological and general health measures. More comparative studies on functional status and quality of life are needed for informed treatment decision making.
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Affiliation(s)
- Caroline A. Kim
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Suraj P. Rasania
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Jonathan Afilalo
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Jeffrey J. Popma
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Lewis A. Lipsitz
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Dae Hyun Kim
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
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Rahnavardi M, Santibanez J, Sian K, Yan TD. A systematic review of transapical aortic valve implantation. Ann Cardiothorac Surg 2013; 1:116-28. [PMID: 23977482 DOI: 10.3978/j.issn.2225-319x.2012.07.04] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 07/06/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) through a transapical approach (TAAVI) for severe aortic stenosis becomes the procedure of choice in cases where patients have peripheral artery disease and unfeasible access due to excessive atherosclerotic disease of the iliofemoral vessels and aorta. The present systematic review aimed to assess the safety, success rate, clinical outcomes, hemodynamic outcomes, and survival benefits of TAAVI. METHODS Electronic searches were performed in 6 databases from January 2000 to February 2012. The primary end points included feasibility and safety. Other end points included echocardiographic findings, functional class improvement, and survival. RESULTS After applying the inclusion and exclusion criteria, 48 out of 154 shortlisted potentially relevant articles were selected for assessment. Of these, 26 studies from 24 centers including total number of 2,807 patients were included for appraisal and data extraction. The current evidence on TAAVI for aortic stenosis is limited to observational studies. Successful TAAVI implantation occurred in >90% of patients. On average, the procedure took between 64 to 154 minutes to complete. The incidence of major adverse events included 30-day mortality (4.7-20.8%); cerebrovascular accident (0-16.3%); major tachyarrhythmia (0-48.8%); bradyarrhythmia requiring permanent pacemaker insertion (0-18.7%); cardiac tamponade (0-11%); major bleeding (1-17%); myocardial infarction (0-6%); aortic dissection/rupture (0-5%); moderate to severe paravalvular leak (0.7-24%); cardiopulmonary bypass support (0-15%); conversion to surgery (0-9.5%); and valve-in-valve implantation (0.6-8%). Mean aortic valve area improved from 0.4-0.7 cm(2) before TAAVI to 1.4-2.1 cm(2) after TAAVI. The peak pressure gradient across the aortic valve decreased from >70 mmHg to <20 mmHg after TAAVI. One-year survival ranged from 49.3% to 82% and the 3-year survival was 58% in 2 series. CONCLUSIONS TAAVI appears to be feasible with a reasonable safety and efficacy portfolio. Randomised controlled trials are required to compare transapical vs. transfemoral TAVI when both techniques are equally feasible.
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Affiliation(s)
- Mohammad Rahnavardi
- The Collaborative Research (CORE) Group, Sydney, Australia; ; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; ; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia
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Li X, Kong M, Jiang D, Dong A. Comparison 30-day clinical complications between transfemoral versus transapical aortic valve replacement for aortic stenosis: a meta-analysis review. J Cardiothorac Surg 2013; 8:168. [PMID: 23819523 PMCID: PMC3722124 DOI: 10.1186/1749-8090-8-168] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 06/25/2013] [Indexed: 11/30/2022] Open
Abstract
Background Since 2002, transapical aortic valve replacement has been developed as a clinical pathway for transcatheter aortic valve implantation (TAVI). However the appropriate role of TA in the AS population versus TF remains unclear. We performed a meta-analysis to assess if TF has any benefit in reduction of 30-day clinical complications in AS. Methods We conducted a comprehensive search on pub-med and web of knowledge from 2002 through September 2012 using following terms: aortic stenosis, aortic valve replacement, transcatheter aortic valve implantation, TAVI, trans-artery, transfemoral, trans-apical. Studies in the original research or review articles were also considered. Included studies must meet the preconditioned criterias. Two investigators independently browsed the studies by title and abstract, finally making decision according to full-text. Disagreements were discussed in group. Results A total of 20 studies met inclusion criteria’s and were included in the analysis (including 4267 patients in TF group, 2242 in TA group). No random clinical trial, one was a retrospective study, others were prospective trials. Our meta-analysis found that TF had the low incidence of 30-day mortality compared with TA procedure (7.5% versus 11.3%). The incidence of stroke at ≤ 30 days was relatively low (3.8% in TF versus 4.0% in TA). Although the incidence of post-operative heart block was high (8.5% versus 7.5%), but no differences were indicated [1.06,95% CI(0.85,1.33)]. Conclusions The result of our meta-analysis suggested that TF may have a low risk for 30-day mortality against TA procedure. No difference was found in the incidence of post-operative stroke and heart block.
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Affiliation(s)
- Xuebiao Li
- Cardiaovascular surgery, Department of second affiliated hospital, school of Medicine, Zhejiang university, No, 88, Jie fang road, Hangzhou, Zhejiang province 310009, China
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[Transcatheter aortic valve replacement: when should it be used in aortic stenosis?]. Wien Med Wochenschr 2012; 162:340-8. [PMID: 22864727 DOI: 10.1007/s10354-012-0136-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 02/08/2012] [Indexed: 10/28/2022]
Abstract
30% of patients with significant aortic stenosis are not considered for operative aortic valve replacement because of the high perioperative risk. An alternative catheter based option for these patients is the transcatheter aortic valve replacement (TAVI). In general, there are two approaches for TAVI: transfemoral and transapical. Transfemoral aortic valve replacement is performed by transcatheter replacement of an aortic valve via the femoral arteries. Transapical valve replacement is achieved by transcatheter implantation via the fifth intercostal space. The most common complications are vessel injuries, bleeding complications, new onset of AV-block, development of paravalvular insufficiency, acute kidney injury, stroke and TIA. The first long-term observations suggest positive results. First clinical trials in a high-risk population show a promising outcome. Therefore TAVI offers a reasonable therapy option for patients with high perioperative risk. Further long-term clinical trials are still pending.
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Samim M, Stella PR, Agostoni P, Kluin J, Ramjankhan F, Sieswerda G, Budde R, der Linden MV, Samim M, Hillaert M, van Herwerden L, Doevendans PA, van Belle E. Transcatheter aortic implantation of the Edwards-SAPIEN bioprosthesis: Insights on early benefit of TAVI on mitral regurgitation. Int J Cardiol 2011; 152:124-6. [DOI: 10.1016/j.ijcard.2011.07.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 07/10/2011] [Indexed: 10/17/2022]
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Gurvitch R, Toggweiler S, Willson AB, Wijesinghe N, Cheung A, Wood DA, Ye J, Webb JG. Outcomes and complications of transcatheter aortic valve replacement using a balloon expandable valve according to the Valve Academic Research Consortium (VARC) guidelines. EUROINTERVENTION 2011; 7:41-8. [PMID: 21550902 DOI: 10.4244/eijv7i1a10] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS There is heterogeneity in the reporting of procedural outcomes and complications following transcatheter aortic valve replacement (TAVR). Recently, new definitions have been proposed by the Valve Academic Research Consortium (VARC) in an effort to standardise these outcomes and improve the quality of future clinical research. The aim of this study is to report the procedural outcomes and complication rates following TAVR in a large sequential patient cohort using a balloon expandable valve according to the new VARC definitions. METHODS AND RESULTS Three hundred and ten consecutive patients undergoing TAVR were assessed, including patients forming our early historical series at the infancy of TAVR. All complication rates were re-evaluated according to VARC definitions. Mean age was 82.2 ± 8.1 years and the Society of Thoracic Surgeons score was 9.4 ± 5.7%. Transfemoral 30-day mortality was 6.8% (3.8% in the second half of the cohort) and transapical 30-day mortality was 13.7% (9.4% in the second half of the cohort). Cardiovascular 30-day mortality was 7.4% and the composite safety endpoint at 30-days was 18.4%. Device success was 80% (post-procedural valve area ≤ 1.2 cm2 in 9.7%). Failure to deliver and deploy a valve occurred in only 3.5%, with 82% (nine cases) occurring in the first half of the experience. Of those who did not meet echocardiographic criteria for device success (valve area ≤ 1.2 cm2, transaortic gradient ≥ 20 mmHg or ≥ moderate aortic incompetence), 90% achieved a New York Heart Association class I/II. Life threatening bleeding complications occurred in 8.4%. In 7.7% of patients, red blood cell transfusions were given without evidence of overt bleeding. Major strokes occurred in 2.3% and acute kidney injury occurred in 6.5%. CONCLUSIONS The VARC consensus guidelines provide a standardised reporting framework for clinical endpoints and complications post TAVR. We report the first series to our knowledge of 30-day outcomes using these definitions utilising a balloon expandable valve system.
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Affiliation(s)
- Ronen Gurvitch
- Department of Cardiology and Cardiothoracic Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
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