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Wunderlich NC, Honold J, Swaans MJ, Siegel RJ. How to Image and Manage Prosthesis-Related Complications After Transcatheter Aortic Valve Replacement. Curr Cardiol Rep 2021; 23:94. [PMID: 34196775 DOI: 10.1007/s11886-021-01522-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW In this review, we provide an overview of potential prosthesis - related complications after transcatheter aortic valve replacement, their incidences, the imaging modalities best suited for detection, and possible strategies to manage these complications. RECENT FINDINGS Therapy for severe aortic valve stenosis requiring intervention has increasingly evolved toward transcatheter aortic valve replacement over the past decade, and the number of procedures performed has increased steadily in recent years. As more and more centers favor a minimalistic approach and largely dispense with general anesthesia and intra-procedural imaging by transesophageal echocardiography, post-procedural imaging is becoming increasingly important to promptly detect dysfunction of the transcatheter valve and potential complications. Complications after transcatheter aortic valve replacement must be detected immediately in order to initiate adequate therapeutic measures, which require a profound knowledge of possible complications that may occur after transcatheter aortic valve replacement, the imaging modalities best suited for detection, and available treatment options.
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Affiliation(s)
| | - Jörg Honold
- Cardiovascular Center Darmstadt, Darmstadt, Germany
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Robert J Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Insights on Embolic Protection, Repositioning, and Stroke: A Subanalysis of the RESPOND Study. J Interv Cardiol 2020; 2020:3070427. [PMID: 32518532 PMCID: PMC7251468 DOI: 10.1155/2020/3070427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/12/2020] [Indexed: 11/21/2022] Open
Abstract
RESPOND is a prospective, single-arm study enrolling 1014 transcatheter aortic valve replacement (TAVR) patients. The objective of this analysis is to assess the impact of cerebral embolic protection (CEP) devices and prosthetic valve repositioning on the risk of neurologic complications in patients treated with the fully repositionable Lotus Valve in the RESPOND postmarket study. Valve repositioning and CEP use were at the operators' discretion. Stroke events were adjudicated by an independent medical reviewer. This analysis assessed the baseline differences among patients according to CEP use and valve repositioning and evaluated the neurological complications at 72 hours after TAVR, hospital discharge, and 30-day follow-up. A multivariate analysis was performed to identify the potential predictors of stroke. Of the 996 patients implanted with the Lotus Valve (mean age: 80.8 years, 50.8% female, STS score 6.0 ± 6.9), 92 cases (9.2%) used CEP. The overall rate of acute stroke/transient ischemic attack (TIA) was 3.0% at 72 hours after TAVR. The 72-hour stroke/TIA rate was 1.1% in patients who had CEP and 3.2% in those who did not. Use of CEP was associated with a 2.1% absolute reduction in the risk of acute neurological events (relative risk reduction: 65.6%), although the difference was not statistically significant (p=0.51). Repositioning of the Lotus Valve occurred in 313/996 procedures (31.4%). The 72-hour rate of stroke/TIA was similar in patients who had valve repositioning (2.9%) compared with those who did not (3.1%; p=0.86). The selective use of a CEP device in the RESPOND study was associated with a nonsignificantly lower risk for stroke within 72 hours. The use of the repositioning feature of the Lotus Valve did not increase the stroke risk.
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Sathananthan J, Ding L, Yu M, Catlin B, Chan A, Charania J, Cheung A, Cook R, Murdoch DJ, Della Siega A, Latham T, Lauck S, Polderman J, Robinson SD, Virani S, Wong D, Wood D, Ye J, Webb JG. Implications of Transcatheter Heart Valve Selection on Early and Late Pacemaker Rate and on Length of Stay. Can J Cardiol 2019; 34:1165-1173. [PMID: 30170672 DOI: 10.1016/j.cjca.2018.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/24/2018] [Accepted: 06/26/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) can cause injury to the atrioventricular conduction system. We evaluated the effect of transcatheter heart valve (THV) type on the rate of new pacemaker implantation and length of hospital stay. METHODS Patients across all hospitals performing transfemoral TAVR in the province of British Columbia between 2012 and 2016 participated in a mandated registry with linkages to provincial health databases. We evaluated 1141 patients undergoing successful transfemoral TAVR for native aortic valve stenosis with 5 commonly used valves. RESULTS Valves implanted were balloon-expandable (BEV) (n = 728), self-expandable (SEV) (n = 341), and mechanically-expandable (MEV) (n = 72). Baseline clinical characteristics were similar between groups: mean age 82.5 years with multiple comorbidities. The mean Society of Thoracic Surgeons predicted risk of mortality was 6.0%. Indwelling temporary pacemakers after TAVR varied by THV type: (BEV) 4.0%, (SEV) 69.3%, and (MEV) 63.0% (P < 0.002). The need for a new permanent pacemaker varied by THV type: (BEV) 6.6%, (SEV) 24.0%, and (MEV) 32.8% at 30 days (P < 0.001). At 1 year, permanent pacemaker rates continued to rise, and remained divergent: (BEV) 8.9%, (SEV) 26.9%, and (MEV) 35.9% (P < 0.001). Median length of stay varied according to THV type: (BEV) 1, (SEV) 3, and (MEV) 4 days (P < 0.001 across groups). Crude mortality rates were not statistically different by THV type, either at 30 days (BEV 3.0%, SEV 2.9%, and MEV 0.0%; P = 0.33), or at 1 year (BEV 10.3%, SEV 15.0%, and MEV 8.3%; P = 0.11). CONCLUSIONS The choice of a THV device was associated with significant differences in the need for post-TAVR temporary pacemakers, hospital length of stay, and both early and late pacemaker implantation rates. These differences may have an impact on patient morbidity and resource utilization.
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Affiliation(s)
| | - Lillian Ding
- Cardiac Services British Columbia, Vancouver, British Columbia, Canada
| | - Maggie Yu
- Cardiac Services British Columbia, Vancouver, British Columbia, Canada
| | - Bonnie Catlin
- Cardiac Services British Columbia, Vancouver, British Columbia, Canada
| | - Albert Chan
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | | | - Anson Cheung
- Centre for Heart Valve Innovation, Vancouver, British Columbia, Canada
| | - Richard Cook
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Dale J Murdoch
- Centre for Heart Valve Innovation, Vancouver, British Columbia, Canada
| | | | - Tim Latham
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Sandra Lauck
- Centre for Heart Valve Innovation, Vancouver, British Columbia, Canada
| | - Jopie Polderman
- Cardiac Services British Columbia, Vancouver, British Columbia, Canada
| | | | - Sean Virani
- St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Daniel Wong
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - David Wood
- Centre for Heart Valve Innovation, Vancouver, British Columbia, Canada
| | - Jian Ye
- Centre for Heart Valve Innovation, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, Vancouver, British Columbia, Canada.
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Conzelmann LO, Würth A, Balthasar V, Neuber C, Tzamalis P, Gonska BD, Schmitt C, Mehlhorn U, Schymik G. Transcatheter aortic valve implantation in severe calcified annulus using the Lotus valve system: Increased incidence of fatal major vascular complications. Catheter Cardiovasc Interv 2019; 95:E21-E29. [PMID: 31115146 DOI: 10.1002/ccd.28339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/02/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES This study reports the outcome of a highly selected transcatheter aortic valve implantation (TAVI) population. BACKGROUND In patients with aortic valve stenosis and severe calcification of the left ventricular outflow tract and/or the annulus, the Boston Scientific Lotus valve provided a low paravalvular leakage rate omitting the risk of annular rupture. METHODS Until now more than 3,600 TAVI procedures were performed at our institution. Between 8/2015 and 2/2017, 634 TAVI procedures were performed, of which 80 TAVI patients with severe calcifications consecutively received the Lotus valve. Valve Academic Research Consortium (VARC)-2 criteria of these procedures were prospectively documented in our institutional TAVI registry. One year follow-up for the Lotus treated patients was completed. RESULTS Mean age was 82.0 ± 5.5 years. Device success was 95.0%. Conversion was required in two cases (2.5%). New permanent pacemaker implantation rate was 33.3%. Vascular complications occurred more frequent in comparison to non-Lotus treated patients (13.8 vs. 8.1%; p < .05): five minor and six major vascular complications (6.3 and 7.5%), including four fatal aortic injuries (three acute aortic dissections type A, one rupture of the aortic arch). Seventy-two-hour and 30-day mortality rates were also higher in Lotus patients (6.3 and 12.5% vs. 0.3 and 2.5%; each p < .05). One-year mortality in Lotus patients was 22.5%. CONCLUSIONS In TAVI procedures with the Lotus valve occurrence of vascular complications including lethal aortic injuries and mortality rates were considerably high. Furthermore, in every TAVI procedure careful examination of the aorta should be mandatory and be a part of planning it.
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Affiliation(s)
| | - Alexander Würth
- Medical Clinic III - Department of Cardiology, ViDia Clinics, Sankt Vincentius Hospital Karlsruhe, Karlsruhe, Germany
| | | | | | - Panagiotis Tzamalis
- Medical Clinic IV - Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Bernd-Dieter Gonska
- Medical Clinic III - Department of Cardiology, ViDia Clinics, Sankt Vincentius Hospital Karlsruhe, Karlsruhe, Germany
| | - Claus Schmitt
- Medical Clinic IV - Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Uwe Mehlhorn
- HELIOS Clinic for Cardiac Surgery Karlsruhe, Karlsruhe, Germany
| | - Gerhard Schymik
- Medical Clinic IV - Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
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Shreenivas S, Schloss E, Choo J, Sarembock I, Lilly S, Kereiakes D. Transcatheter aortic valve replacement and cardiac conduction. Expert Rev Cardiovasc Ther 2019; 17:293-304. [DOI: 10.1080/14779072.2019.1598264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Satya Shreenivas
- The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA
| | - Edward Schloss
- The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA
| | - Joseph Choo
- The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA
| | - Ian Sarembock
- The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA
| | - Scott Lilly
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Dean Kereiakes
- The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA
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Solomonica A, Choudhury T, Bagur R. Newer-generation of Edwards transcatheter aortic valve systems: SAPIEN 3, Centera, and SAPIEN 3 Ultra. Expert Rev Med Devices 2018; 16:81-87. [DOI: 10.1080/17434440.2019.1555465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - Rodrigo Bagur
- London Health Sciences Centre, London, Canada
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
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del Val D, Ferreira-Neto AN, Asmarats L, Maes F, Guimaraes L, Junquera L, Wintzer J, Fischer Q, Barroso de Freitas Ferraz A, Puri R, Rodés-Cabau J. Transcatheter aortic valve replacement: relative safety and efficacy of the procedure with different devices. Expert Rev Med Devices 2018; 16:11-24. [DOI: 10.1080/17434440.2019.1552132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- David del Val
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | - Lluis Asmarats
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Frédéric Maes
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | - Lucia Junquera
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Jérome Wintzer
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Quentin Fischer
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | - Rishi Puri
- Department of Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
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Solomonica A, Choudhury T, Bagur R. The mechanically expandable LOTUS Valve and LOTUS Edge transcatheter aortic valve systems. Expert Rev Med Devices 2018; 15:763-769. [DOI: 10.1080/17434440.2018.1536543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Amir Solomonica
- Cardiology Division, London Health Sciences Centre, London, Ontario, Canada
| | - Tawfiq Choudhury
- Cardiology Division, London Health Sciences Centre, London, Ontario, Canada
| | - Rodrigo Bagur
- Cardiology Division, London Health Sciences Centre, London, Ontario, Canada
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
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Thakur K, Nazif TM, Khalique OK, Paradis JM, Harjai KJ. Transcatheter aortic valve replacement: The year in review 2017. J Interv Cardiol 2018; 31:543-552. [PMID: 30225907 DOI: 10.1111/joic.12562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 08/23/2018] [Accepted: 08/23/2018] [Indexed: 01/20/2023] Open
Abstract
This article is a continuation of our previously published annual reviews of transcatheter aortic valve replacement (TAVR). In 2017, TAVR further established a foothold in the management of intermediate risk patients with the publication of SURTAVI trial. Randomized trials also addressed the use of cerebral protection during TAVR and single versus dual antiplatelet therapy after TAVR. Newer generation valve systems continued to be studied for their efficacy and safety. This paper summarizes the major studies published in 2017.
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Affiliation(s)
- Kamia Thakur
- Department of Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania
| | - Tamim M Nazif
- Department of Cardiology, Structural Heart and Valve Center, Columbia University Medical Center, New York, New York
| | - Omar K Khalique
- Department of Cardiology, Structural Heart and Valve Center, Columbia University Medical Center, New York, New York
| | - Jean-Michel Paradis
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Kishore J Harjai
- Department of Cardiology, Geisinger Northeast, Pearsall Heart Hospital, Wilkes Barre, Pennsylvania
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Mangieri A, Montalto C, Pagnesi M, Lanzillo G, Demir O, Testa L, Colombo A, Latib A. TAVI and Post Procedural Cardiac Conduction Abnormalities. Front Cardiovasc Med 2018; 5:85. [PMID: 30018969 PMCID: PMC6038729 DOI: 10.3389/fcvm.2018.00085] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/12/2018] [Indexed: 01/20/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a worldwide accepted alternative for treating patients at intermediate or high risk for surgery. In recent years, the rate of complications has markedly decreased except for new-onset atrioventricular and intraventricular conduction block that remains the most common complication after TAVI. Although procedural, clinical, and electrocardiographic predisposing factors have been identified as predictors of conduction disturbances, new strategies are needed to avoid such complications, particularly in the current TAVI era that is moving quickly toward the percutaneous treatment of low-risk patients. In this article, we will review the incidence, predictive factors, and clinical implications of conduction disturbances after TAVI.
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Affiliation(s)
| | | | | | | | - Ozan Demir
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Azeem Latib
- IRCCS San Raffaele Scientific Institute, Milan, Italy
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Outcomes with a latest generation self-expandable, intra-annular, re-sheathable transcatheter heart valve system: analysis of patients with impaired left ventricular function and determinants for pacemaker implantation. Clin Res Cardiol 2018; 107:914-923. [DOI: 10.1007/s00392-018-1263-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/24/2018] [Indexed: 01/09/2023]
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Sinning JM, Grube E. Two sides to every story: the trade-off between paravalvular leakage and the occurrence of conduction disturbances in transcatheter heart valves. EUROINTERVENTION 2017; 13:777-779. [DOI: 10.4244/eijv13i7a113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bagur R, Choudhury T, Mamas MA. Transcatheter aortic valve implantation with the repositionable and fully retrievable Lotus Valve System TM. J Thorac Dis 2017; 9:2798-2803. [PMID: 29221243 DOI: 10.21037/jtd.2017.08.78] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rodrigo Bagur
- Division of Cardiology, London Health Sciences Centre, Departments of Medicine and Epidemiology & Biostatistics, Western University, London, Ontario, Canada.,Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
| | - Tawfiq Choudhury
- Division of Cardiology, London Health Sciences Centre, Departments of Medicine and Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
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Transcatheter aortic valve replacement with new-generation devices: A systematic review and meta-analysis. Int J Cardiol 2017; 245:83-89. [PMID: 28760396 DOI: 10.1016/j.ijcard.2017.07.083] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 06/17/2017] [Accepted: 07/21/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to conduct a weighted meta-analysis to determine the rates of acute (≤30days) major outcomes after (TAVR) with second-generation devices. METHODS A comprehensive search of multiple electronic databases from January 2011 to May 2017 was conducted using predefined criteria. New-generation TAVR devices were defined as any device which received CE mark approval or is still under evaluation for CE marking after CoreValve and SAPIEN XT prostheses. RESULTS A total of 37 studies including 10,822 patients met inclusion criteria and were included in the analysis. Devices investigated in the studies were the following: SAPIEN 3 (n=5423, 45.9%), Lotus Valve (n=3007, %), Portico (n=130, 1.1%), JenaValve (n=345, 2.9%), Symetis Acurate (n=1314, 11,1%), and Evolut R (n=1603, 13.6%). Thirty-day all-cause and cardiovascular 30-day death were 2.2% (95% CI: 1.6% to 2.8%) and 1.6% (95% CI: 0.9% to 2.3%), respectively; Any stroke and major/disabling stroke occurred at a pooled estimate rate of 2.6% (95% CI: 2.0% to 3.3%) and 0.9% (95% CI: 0.2% to 1.6%), respectively; life-threatening bleeding, 3.9% (95% CI: 2.9% to 5.0%); major vascular complications, 4.5% (95% CI: 3.7% to 5.4%); pacemaker implantation, 16.2% (95% CI: 12.7% to 19.6%); more than mild aortic regurgitation, 1.6% (95% CI: 0.9 to 2.3). CONCLUSIONS Second-generation TAVR devices are associated with very low mortality and major complications rates at 30-day, and improved prosthesis performance with <2% of patients having more than mild post-procedural aortic regurgitation. On the other hand, the need for pacemaker implantation seems to remain an unresolved issue, and warrants further investigation.
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