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Objectives: To evaluate survival and cause of death in a consecutive patient cohort undergoing Transcatheter Aortic Valve implantation (TAVI)., Background: TAVI is a valid treatment option in patients with severe Aortic Stenosis (AS) who are deemed at (very) high operative risk. Because of (non-)cardiac comorbidities life expectancy in this patient, population is reduced when compared with the general population., Methods: Consecutive patients with symptomatic aortic stenosis undergoing TAVI between November 2005 and December 2011 were included. (1) Survival status was obtained from the Dutch Civil Registry, (2) cause of death was derived by reviewing hospital charts, and (3) contacting referring physicians and patients' general practitioners., Results: Two hundred and thirty-seven consecutive patients were included with an overall all-cause mortality of 31% at a median follow up of 13 months (IQR 2-24 months). Four patients (1.6%) died < 48 hr of the TAVI procedure, and another 16 patients died up to the 30-day interval representing an all-cause 8.4% 30-day mortality. Between 30 days and 1-year another 30 patients died. Twenty-four patients died >1 year post TAVI. The predominant cause of death >48 hr post TAVI was noncardiac. One third of these deaths were due to sepsis/infection, one-fifth to cancer and stroke in 16%., Conclusions: In our series of AS patients undergoing TAVI, the cause of death >48 hr post procedure was predominantly noncardiac at every time interval. Mortality was driven by sepsis/infection, cancer, and stroke. Rigorous patient selection may improve outcome after TAVI., (Copyright © 2012 Wiley Periodicals, Inc., a Wiley company.)

We investigate the accuracy of a new software system (C-THV, Paieon) designed to calculate the optimal projection (OP) view for transcatheter aortic valve implantation (TAVI) based on two aortograms, and its agreement with the operator's choice. An optimal fluoroscopic working view projection with all three aortic cusps depicted in one line, is crucial during TAVI. In our institution selection of the OP is based on multislice computed tomography (MSCT). Seventy-three consecutive patients referred for TAVI were divided into two groups. For the first group (53 patients, retrospective cohort) we compared the OP views estimated by C-THV with the ones estimated by MSCT. For the second group (20 patients, prospective cohort), we compared the OP views estimated by C-THV with the operator's choice during TAVI. For the retrospective cohort, the mean absolute difference (mean ± SD) between C-THV and MSCT was 6.6 ± 4.9 degrees. In 77% of the cases the mean difference between C-THV and MSCT was <10 degrees. For the prospective cohort, the mean absolute difference (mean ± SD) between C-THV and the operator's choice was 5.5 ± 3.4 degrees. A mean difference of <10 degrees was found in 90% of the cases. In this study we found that the C-THV software estimated the OP view for TAVI with good accuracy. The level of agreement between C-THV and either the MSCT or the operator's choice was deemed satisfactory, with the vast majority of observed differences being <10 degrees., (© 2010 Wiley-Liss, Inc.)

Aims: Transcatheter aortic valve implantation (TAVI) requires large bore catheters. Access site complications, therefore, can be a concern. The aim of this study is to present the 30-day incidence of major and minor vascular complications in patients treated with the third generation 18 Fr Medtronic CoreValve System., Methods and Results: We prospectively evaluated the vascular complications occurring in all patients treated with the 18 Fr Medtronic CoreValve System between October 2006 and October 2009 in the Thoraxcenter using various proposed definitions. Ninety-nine consecutive patients were treated with TAVI using the 18 Fr Medtronic CoreValve System. Vascular events were encountered in 13 patients (13%), seven of these cases (54%) were related to incomplete arteriotomy closure with the Prostar device which is the default access closure technique in our centre. Depending on how major vascular complications were defined, the incidence varied from 4 to 13%. Blood transfusions in combination with surgical or percutaneous intervention were required in eight cases., Conclusions: Transcatheter aortic valve implantation with the 18 Fr Medtronic CoreValve System(R) has a 4 to 13% vascular complications' rate. More than half of the vascular events were due to incomplete Prostar arteriotomy closure, despite its use by experienced operators. Current percutaneous closure devices for these large arteriotomies seems suboptimal. Uniformity in how to define TAVI related vascular complications is needed.

Aims: The morbidity and mortality of surgical aortic valve replacement are increased in elderly patients with multiple high risk comorbid conditions. Percutaneous prosthetic aortic valve replacement (PAVR) via the femoral arterial approach is feasible in selected patients, who are poor operative candidates, with satisfactory short term outcomes. It is conceivable that patients with poor LV function may benefit from periprocedural cardio-circulatory support. We evaluated the short-term safety and efficacy of using the TandemHeart PTVA System (p-LVAD) to deliver extracorporeal circulatory support in patients undergoing PAVR., Methods and Results: Between April 2006 and May 2007 the TandemHeart was used in 10 patients (age: range 64-85, median 80) undergoing elective PAVR using the CoreValve Revalving System. The median (range) time for implementation of circulatory support was 32 (22-40) minutes. A pump flow up to 4.6 L/min was achieved. Systemic haemodynamics were maintained in all but one patient. The median (range) systemic arterial pressure (MBP) was 77 (67-89) mmHg at baseline and 76 (61-91) mmHg after pump functioning. A major systolic blood pressure drop (systolic blood pressure < 70 mmHg, pulse pressure < 10 mmHg, occurred in one patient due to PAVR related pericardial tamponade. Median (range) duration of support was 64 (60-93) minutes. Successful weaning was achieved in all patients. There was one in hospital death. Survival at 12 months was 90%, at 15 months 70%. Vascular access site complications were seen in two patients. One patient suffered a mild to moderate access site bleeding, one a local wound infection. There was no technical device failure., Conclusions: The TandemHeart-PTVA may provide a valuable safeguard during high risk PAVR procedures and enables precise delivery of the CoreValve prosthesis. The rate of device related cardiac and vascular complications was acceptable.

We retrospectively evaluated fungaemia over the period 1996 to 2001 in five university hospitals. Over 350,000 blood cultures were collected during more than 7 million days of hospitalisation. The average rate of fungaemia over the six-year period was 0.82 per 10,000 patient days (range 0.65 to 1.21 per 10,000 patient days). The proportion of bloodstream infections caused by Candida albicans remained stable throughout the study period with a mean of 53% (range 48 to 62%). This is a change from trends described in previous studies, including a survey performed in the Netherlands. This study shows a new, stable rate of fungaemia and no further signs of increasing rate of infections due to non-albicans Candida species. Susceptibility to all tested antifungal agents remained stable throughout the study period.