EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
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Aortic regurgitation (AR) is an important predictor of adverse prognosis after transcatheter aortic valve implantation (TAVI) by both self-expanding and balloon-expandable prostheses and is predominantly paravalvular (PV). The mounting evidence for moderate/severe PV AR as an independent predictor of mortality is discussed. Moreover, there is an unclear impact on prognosis of mild PV AR that is most likely the result of imperfect assessment of this complication, which currently remains semi-quantitative. The relevance of its accurate quantification to reliable prognostication is described, along with how this data might be used to guide intervention and optimise outcomes of patients with PV AR.
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For appropriately selected patients with severe mitral regurgitation, percutaneous mitral valve repair with the MitraClip® system is a promising alternative to open chest surgery. The procedure requires transoesophageal echocardiographic guidance and is performed under general anaesthesia. However, many patients undergoing percutaneous repair are at high risk for complications related to anaesthesia. We report our initial experience in the use of the MitraClip® system under deep sedation and local anaesthesia in five consecutive cases. ⋯ The implantation of a MitraClip® is feasible under local anaesthesia and sedation. In patients at high risk for complications related to general anaesthesia, percutaneous mitral valve repair under local anaesthesia may be a viable alternative.
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The aim of this study was to identify the incidence and risk factors for acute kidney injury (AKI) after TAVI, a potentially serious complication of transcatheter aortic valve implantation (TAVI) that has been redefined by the Valve Academic Research Consortium (VARC). ⋯ More than one third of patients sustain AKI after TAVI using the Edwards bioprosthesis, as defined by the VARC-modified RIFLE score. AKI increased the mortality at both 30 days and at one year. A history of diabetes mellitus, peripheral vascular disease and higher chronic kidney disease stage had the strongest independent associations with post-TAVI AKI.