The Journal of invasive cardiology
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Comparative Study
The incidence of transcatheter aortic valve implantation-related heart block in self-expandable Medtronic CoreValve and balloon-expandable Edwards valves.
Transcatheter aortic valve implantation (TAVI) has been performed at Waikato Hospital for high-risk severe symptomatic aortic stenosis patients who are considered unsuitable for conventional cardiac surgery for the last 3 years. The Medtronic CoreValve (MCV) is a self-expandable device, while the Edwards SAPIEN valve (EV) requires the use of a balloon to expand the device. This observational study reports and compares the incidence of heart block in both Medtronic and Edwards transcatheter valves. ⋯ MCV implantation is associated with a higher incidence of significant AV block requiring PPM implantation and LBBB compared to EV. The overall rate of PPM requirement post MCV TAVI is, however, lower than previously published data. Pre-existing RBBB may help in predicting the likelihood of developing significant AV block.
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Patients in whom femoral arterial access is not feasible pose a challenge in terms of hemodynamic support during high-risk percutaneous coronary intervention. Patient's height adds another challenge given the fixed lengths of available intra-aortic balloon pumps, in terms of achieving an adequate infrasubclavian positioning in the descending thoracic aorta. We report a case where a modified intra-aortic balloon pump helped achieve a successful result in a patient undergoing intervention of an unprotected left main using bilateral arm approach.