Ministernotomy for Aortic Valve Replacement Versus Conventional Sternotomy, a Choice for a Better outcome

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Refaat Mohamed Refaat ◽  
Gamal Samy ◽  
Faisal Morad ◽  
Nabil Abd Gawad
Keyword(s):  
Aortic Valve ◽  
Blood Loss ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Statistical Difference ◽  
Statistical Significance ◽  
P Value ◽  
Safe Procedure ◽  
Transfusion Requirements ◽  
Renal Complication

Abstract Background ​ In the era of minimal invasive cardiac surgery, Ministernotomy Aortic valve .replacement have been proposed as an alternative to conventional full sternotomy approach Aim of the Work ​: ​​To evaluate the safety and efficacy of AVR through ministernotomy in comparison to full sternotomy AVR in terms of Cardiac cause mortality, Neurological and .Renal complication​s Patients and Methods ​After gaining the institutional ethical committee approval, the study included all patients who underwent isolated, DE novo, open aortic valve replacement during the period from June 2017 till June 2019 performed by multiple surgeons at cardiothoracic .academy Ain Shams University Results ​ The study included 60 patients; 32 patients performed through full sternotomy (53.3%) and 28 patients through ministernotomy (46.6%).​ ​Post-operative arrhythmias occurred in full sternotomy in 6 cases (18.8%) where in mini-sternotomy, only 3 cases (12%) developed arrhythmias with no significant statistical difference (p value = ​0.558)​. Cerebrovascular stroke was recorded 1 patient (3%) versus 4 cases (14.3%) in the full sternotomy versus the ministernotomy groups respectively with no Statistical difference between the 2 groups (p value = 0.119).​ Postoperative acute renal impairment was recorded​ in 3 cases (9.4%) vs 2 patients (7.1%) in the full sternotomy vs the ministernotomy groups respectively (p value = 0.755). There was no​ mortality in either groups. Mean post-operative Ventilation hours were 17.21hrs with SD ± 11.026 versus 14.97hrs with SD ​± ​6.473 (p value is 0.35) for the full sternotomy versus the ministernotomy groups respectively. Mean blood loss was 305.51ml with SD ± 282.662 versus 230.36ml with SD ​± ​247.708 (p value is 0.277) for the full versus the ministernotomy groups respectively. Mean units of blood transfused was 2.31Units with SD ​± ​0.926 versus 1.14Units with SD ​±​ 0.591 in the full sternotomy versus the ministernotomy groups with high statistical significance between both groups (p value less than 0.01). Mean ICU stay was 2.66 days with SD ​±​ 0.915 and was 3.1days with SD ​±​ 2.743 (p .value is 0.424) for the full sternotomy versus the ministernotomy groups respectively Conclusion ​ Ministernotomy Aortic valve replacement was found to be a safe procedure​ compared to full sternotomy approach. Patients who had their surgery through the mini approach had less amount of blood loss, blood transfusion requirements, ventilation time which all led to less duration of ICU and hospital stay, resulting in a better outcome for the .patients

scholarly journals Predictors of Early Mortality After Aortic Valve Replacement in Middle-Aged Rheumatic Patients

2019 ◽  
Vol 1 (3) ◽  
pp. 105-111
Author(s):  
Essam Hassan ◽  
Sameh Sersar
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Median Sternotomy ◽  
Early Postoperative Period ◽  
Early Mortality ◽  
P Value ◽  
The Mean ◽  
Valve Prostheses ◽  
Rheumatic Patients

Background: Several risk factors, including emergency surgery, predicted early mortality after aortic valve replacement (AVR).  Euroscore II is used to predict the mortality after cardiac operations. We aimed to review our experience in AVR and determine the early mortality predictors Methods: We collected the data of 200 rheumatic patients who had standard AVR in two centers. Median sternotomy and cardiopulmonary bypass were used in all patients. Transcatheter and minimally invasive aortic valve replacement patients were excluded. We used 15 types of aortic valve prostheses, either mechanical or biological. Follow-up echocardiography was done in the intensive care unit, on discharge, and one month after discharge.     Results: 128 patients (64%) had mechanical AVR, and 130 patients (65%) were males. The mean age was 48.2 ± 19 years, and body mass index was 1.8 ± 0.2 Kg/m2. The mean preoperative ejection fraction was 54 ± 9.4 %, end-diastolic dimension was 5.3 ± 0.8 cm, and end-systolic dimension was 3.5 ± 0.9 cm. Nine patients (4.5%) died in the early postoperative period (6 months). Euroscore II was the only factor significantly associated with early mortality (P value= 0.031).  The mean Euroscore II was 1.3 ± 0.9 and 10.1 ± 10.7 for survivors and non-survivors, respectively.  Conclusion: Euroscore II score was significantly associated with early mortality after aortic valve replacement in rheumatic patients and can be used for risk stratification in those patients.

scholarly journals Aortic Root Enlargement during Aortic Valve Replacement in Adults

2021 ◽  
pp. 56-62
Author(s):  
Miroslav M. Furman ◽  
Sergey V. Varbanets ◽  
Oleksandr M. Dovgan
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Severe Aortic Stenosis ◽  
Aortic Root Replacement ◽  
Safe Procedure ◽  
Aortic Pathology ◽  
Aortic Root Enlargement

Aortic valve replacement is a gold standard in the treatment of patients with severe aortic stenosis or combined aortic pathology. However, aortic valve pathology is often associated with a narrow aortic orifice, particularly in patients with severe aortic stenosis. In 1978, Rahimtoola first described the term of prosthesis-patient mismatch. He noted that effective orifice area of the prosthesis is smaller than that of the native valve. To minimize this complication, there are several surgical strategies: aortic root enlargement (ARE), implantation of a frameless biological prosthesis in the native position, neocuspidalization procedure, Ross procedure, aortic root replacement with xenograft or homograft. ARE is an excellent option, however, some authors outline additional perioperative risks. The aim. To analyze immediate results of ARE during isolated aortic valve replacement and in cases when it is combined with other heart pathologies. Materials and methods. Our study included 63 patients who underwent ARE. Isolated aortic valve replacement was performed in the majority of cases, but often aortic root replacement procedure was combined with coronary artery bypass grafting. Results and discussion. One of 63 patients died (hospital mortality 1.6%) at an early hospital stage (30 postoperative days). Measurement of the aortic valve ring was performed by two methods, through preoperative echocardiography and perioperative measurement using a valve sizer. However, perioperative dimension was chosen as the basis for the calculations. In 62 patients, the perioperative diameter of the aortic valve ring ranged from 19 to 23 mm, only one patient had a diameter of 24 mm. According to our findings, ARE enabled to achieve an average aortic ring size increase of 2.68 cm2 (from 1.5 to 3.4 cm2) and to prevent prosthesis-patient mismatch in 42 (66.7%) cases. Conclusions. Prosthesis-patient mismatch is considered a serious complication in the postoperative period. Narrow aortic root is a common pathology that should be considered during surgery. ARE is a safe procedure and is not associated with an increased risk of mortality and complications.

scholarly journals Joint preoperative transthoracic and intraoperative transoesophageal echocardiographic assessment of functional mitral regurgitation severity provides better association with long-term mortality

2020 ◽  
Vol 32 (1) ◽  
pp. 9-19
Author(s):  
Shyamal R Asher ◽  
Gregory W Malzberg ◽  
Chin Siang Ong ◽  
Raymond J Malapero ◽  
Huan Wang ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Postoperative Mortality ◽  
Functional Mitral Regurgitation ◽  
P Value ◽  
Operative Strategy ◽  
Prediction Of Mortality

Abstract OBJECTIVES Functional mitral regurgitation (MR) is observed with ischaemic heart disease or aortic valve disease. Assessing the value of mitral valve repair or replacement (MVR/P) is complicated by frequent discordance between preoperative transthoracic echocardiographic (pTTE) and intraoperative transoesophageal echocardiographic (iTOE) assessment of MR severity. We examined the association of pTTE and iTOE with postoperative mortality in patients with or without MR, at the time of coronary artery bypass grafting (CABG) and/or aortic valve replacement without MVR/P. METHODS Medical records of 6629 patients undergoing CABG and/or aortic valve replacement surgery with or without functional MR and who did not undergo MVR/P were reviewed. MR severity assessed by pTTE and iTOE were examined for association with postoperative mortality using proportional hazards regression while accounting for patient and operative characteristics. RESULTS In 72% of 709 patients with clinically significant (moderate or greater) functional MR detected by pTTE, iTOE performed after induction of anaesthesia demonstrated a reduction in MR severity, while 2% of patients had increased severity of MR by iTOE. iTOE assessment of MR was better associated with long-term postoperative mortality than pTTE in patients with moderate MR [hazard ratio (HR) 1.31 (1.11–1.55) vs 1.02 (0.89–1.17), P-value for comparison of HR 0.025] but was not different for more than moderate MR [1.43 (0.96–2.14) vs 1.27 (0.80–2.02)]. CONCLUSIONS In patients undergoing CABG and/or aortic valve replacement without MVR/P, these findings support intraoperative reassessment of MR severity by iTOE as an adjunct to pTTE in the prediction of mortality. Alone, these findings do not yet provide evidence for an operative strategy.

P909Echocardiographic Assessment of Left Ventricular Function in Patients with Aortic Stenosis and the short-term effects after intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Alfarih ◽  
C Leu ◽  
J Moon ◽  
A Hughes ◽  
P Nihoyannopoulos ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
P Value ◽  
Compensatory Mechanisms ◽  
Surgical Aortic Valve Replacement ◽  
The Impact

Abstract Introduction Aortic stenosis (AS) is the most prevalent form of acquired valvular heart disease, it affects ∼2% of people aged over 75. Series of compensatory mechanisms occur, in order for LV to adapt to high pressure overload. Aortic valve replacement has been the mainstay AS treatment either surgically or percutaneously. The evaluation of myocardial strains after Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) is still underexplored and there is no single study to date scouting the difference between TAVI and SAVR. Aim To assess the impact of unloading LV after TAVI and SAVR on LV remodelling. Methods In this prospective study, we have recruited 111 patients (75±11 years, 63% were females) with varying degrees of aortic stenosis. Of the 111 patients, 43 patients and 11 patients underwent TAVI and SAVR respectively between November 2017 and May 2018. Demographics, clinical and echocardiographic measurements along with speckle tracking parameters were recorded for all participants and again 4±2 weeks after intervention. Results Pre-TAVI LV-GLS mean was −10.8±3.5% and after implantation of aortic prosthesis immediate improvement of the myocardial deformation to −13.98±2.9% was observed after one month of the intervention, mean difference of −3.16% following procedure. There was an evidence of significant improvement in LV-GRS after TAVI (44.86±12.9% to 49.77±10.8%, P value= 0.047). Per contra, when comparing pre and post TAVI LV-GCS, no statistical evidence was noted. However, a difference of −2.4% in GCS following the intervention might be clinically important, but no previous evidence can support this. This is attributed to the poor reproducibility and yet not available standardisation. Table 1 Variables TAVI (n=43) SAVR (n=11) P value† Pre Post P* value Pre Post P* value GLS (%) −10.82±3.5 −13.98±2.9 <0.001 −12.75±4.3 −16.1±2 0.021 0.152 GCS (%) −30.1±8.1 −32.49±9.2 0.134 −27±9.8 −33.9±4.69 0.063 0.062 GRS (%) 44.86±12.9 49.77±10.8 0.047 36.6±13.3 44.97±4.9 0.074 0.058 Data are expressed as mean ± SD. Comparisons were performed using paired Student's t tests. *Pre and post intervention. †Post TAVI vs. post SAVR. Comparison done using unpaired t test of the differences. Conclusion Significant improvement was evident in myocardial deformation parameters – in particular GLS – after weeks of the intervention demonstrating a strong evidence of reversed remodelling following SAVR and TAVI.

P1851Long-term outcomes of transcatheter versus surgical aortic valve replacement in low risk, elderly patients with severe aortic stenosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D.-H Kang ◽  
J K Oh ◽  
S.-A Lee ◽  
S Lee ◽  
D.-H Kim ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Cardiovascular Event ◽  
Severe Aortic Stenosis ◽  
P Value ◽  
Cardiac Mortality ◽  
Surgical Risk

Abstract Background Although surgical aortic valve replacement (SAVR) is recommended for symptomatic severe aortic stenosis (AS) patients at low surgical risk, there is a growing need for an expansion of transcatheter aortic valve replacement (TAVR) as an alternative to SAVR for elderly AS patients at low operative risk. Purpose We tried to compare the long-term clinical outcomes of TAVR versus SAVR in elderly AS patients (≥80 years old) at low surgical risk. Methods We consecutively enrolled 261 elderly patients (131 men; 83±3 years of age) with symptomatic severe AS and EuroSCORE II <4%, who underwent SAVR or TAVR from 2010 to 2018. Heart Team made the decision between SAVR and TAVR according to the individual patient's preference and characteristics. SAVR was performed on 93 patients (SAVR group), whereas TAVR was chosen for 168 patients (TAVR group). The primary end point was cardiac mortality including procedure-related death, and the secondary end point was all-cause death and cardiovascular event. Results Baseline characteristics were similar between the two groups, but the TAVR group was significantly older than the SAVR group (83±3 vs 82±2 years; p<0.01). Device was successfully implanted in all the patients and there was 1 in-hospital mortality in the TAVR group and 3 in-hospital mortalities in the SAVR group (p=0.13). During a median follow-up of 24 months (IQR, 9–45 months), there were 22 deaths (13.1%) including 8 cardiac deaths (4.8%) in the TAVR group and 16 deaths (17.2%) including 9 cardiac deaths (9.7%) in the SAVR group. The rates of the primary and secondary end points were similar between two groups in the overall cohort and the propensity score-matched cohort (table). On subgroup analysis according to the presence of coronary artery disease (CAD), the only independent variable associated with cardiac mortality, the SAVR group had a significantly higher cardiac mortality rate than the TAVR group (15±7% vs 7±6% at 5 years, p=0.048) in 185 (71%) patients without CAD, whereas there was no significant difference among those with CAD. Harzard ratio for clinical outcomes TAVR (n=168) SAVR (n=93) Overall cohort TAVR (n=76) SAVR (n=76) PS-matched cohort HR (95% CI) p value HR (95% CI) p value Cardiac mortality 8 9 0.65 (0.25–1.71) 0.386 2 7 0.34 (0.07–1.61) 0.173 All-cause mortality 22 16 1.08 (0.56–2.08) 0.831 6 12 0.86 (0.30–2.43) 0.774 Cardiovascular event* 18 12 1.09 (0.52–2.28) 0.826 6 10 0.72 (0.26–1.98) 0.525 *Cardiovascular event was defined as the composite of cardiac mortality, hospitalization for heart failure, stroke, myocardial infarction, and reoperation. Conclusion In elderly AS patients at low surgical risk, TAVR was similar to SAVR with respect to long-term clinical outcomes. TAVR should be considered a treatment option for elderly patients who refuse to undergo surgery despite low risk.

scholarly journals Minimal invasive aortic valve replacement: associations of radiological assessments with procedure complexity

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Bruce R. Boti ◽  
Vikash G. Hindori ◽  
Emilio L. Schade ◽  
Athina M. Kougioumtzoglou ◽  
Eva C. Verbeek ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Regression Models ◽  
Statistical Significance ◽  
Minimal Invasive ◽  
Suture Technique ◽  
Preoperative Imaging ◽  
Preoperative Ct ◽  
Valve Implantation

Abstract Objectives Limited aortic annulus exposure during minimal invasive aortic valve replacement (mini-AVR) proves to be challenging and contributes to procedure complexity, resulting in longer procedure times. New innovations like sutureless valves have been introduced to reduce procedure complexity. Additionally, preoperative imaging could also contribute to reducing procedure times. Therefore, we hypothesize that Computed Tomography (CT)-image based measurements are associated with mini-AVR complexity. Methods One hundred patients who underwent a mini-sternotomy and had a preoperative CT scan were included. With a CT-based mini-AVR planning tool, we measured access distance, access angle, annulus dimensions, and calcium volume. The associations of these measurements with cardiopulmonary bypass (CPB) time and aortic cross-clamp (AoX) time were assessed using univariable and multivariable regression models. In the multivariable models, these measurements were adjusted for age and suture technique. Results In the univariable regression models, calcium volume and annulus dimensions were associated with longer CPB and AoX time. After adjusting for age and suture technique, increasing calcium volume was still associated with longer CPB (adjusted β-coefficient 0.002, 95%-CI (0.005, 0.019), p-value = 0.002) and AoX time (adjusted β-coefficient 0.010, 95%-CI (0.004, 0.016), p-value = 0.002). However, after adjusting for these confounders, the association between annulus dimensions and procedure times lost statistical significance. Conclusion Increase in calcium volume are associated with longer CPB and AoX times, with age and sutureless valve implantation as independent confounders. In contrast to previous studies, access angle was not associated with procedure complexity.

Abstract 190: Risk Factors and Outcomes of Hyperbilirubinemia Following Transcatheter Aortic Valve Replacement

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Stephanie Jou ◽  
Li Zhang ◽  
Batyrjan Bulibek ◽  
Mohammad El-Hajjar ◽  
Augustin Delago ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Valve ◽  
Confidence Interval ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Hazard Ratio ◽  
P Value ◽  
Transcatheter Aortic Valve ◽  
Significant Difference

Background: It has been established that postoperative hyperbilirubinemia is associated with increased mortality and morbidity after cardiac surgery. However, hyperbilirubinemia after transcatheter aortic valve replacement (TAVR) has not yet been a subject of clinical research. We evaluated the incidence and risk factors of post-TAVR hyperbilirubinemia, and aimed to determine its prognostic significance. Methods: A retrospective observational study was conducted on 241 consecutive TAVR patients between January 2011 and December 2014 in our institution. We excluded 15 patients with documented chronic hepatic or biliary disorders, or prior liver transplant. Hyperbilirubinemia was defined as any value above the upper limit of normal total bilirubin within 1 week of TAVR. Results: Eighty-two patients out of 226 (36.3%) had post-TAVR hyperbilirubinemia. After adjustment for confounders, there was no significant difference in in-hospital mortality (3.7% (3 of 82) vs. 1.4% (2 of 144); p-value = 0.26) and 1-year mortality (7.3% (6 of 82) vs 5.6% (8 of 144); p-value = 0.60) between patients with and without elevated bilirubin following TAVR. However, there was a trend for hyperbilirubinemic patients to have a longer intensive care unit stay (145.3 +/-202.2 hours vs. 113.2 +/-93.4 hours; p-value = 0.14) and hospital stay (14.1 +/-11.2 days vs. 12.1 +/-8.6 days; p-value = 0.16). Multivariable analysis revealed that preoperative hyperbilirubinemia (hazard ratio 62.88, 95% confidence interval 15.80 to 250.32; p-value <0.0001) and preoperative atrial fibrillation (hazard ratio 2.40, 95% confidence interval 1.21 to 4.78; p-value = 0.01) were strongly associated with post-TAVR hyperbilirubinemia. Conclusions: The cause of post-TAVR hyperbilirubinemia may be multifactorial. It is not a rare event and may impact the short-term outcomes. Thus, monitoring bilirubin should be considered an integrated part of TAVR patient care. Optimal management of post-TAVR hyperbilirubinemia remains challenging.

scholarly journals Plasma fibrin clot properties affect blood loss after surgical aortic valve replacement for aortic stenosis

2018 ◽  
Vol 55 (2) ◽  
pp. 224-231 ◽  
Author(s):  
Piotr Mazur ◽  
Joanna Natorska ◽  
Dorota Sobczyk ◽  
Bogusław Gawęda ◽  
Krzysztof Bartuś ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Blood Loss ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Fibrin Clot ◽  
Surgical Aortic Valve Replacement

scholarly journals AORTIC VALVE REPLACEMENT

2015 ◽  
Vol 22 (12) ◽  
pp. 1565-1568
Author(s):  
Ghulam Hussain ◽  
Naseem Ahmad ◽  
Sohail Ahmad ◽  
Mirza Ahmad Raza Baig ◽  
Sara Zaheer
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Precise Determination ◽  
Aortic Annulus ◽  
P Value ◽  
Mechanical Prosthesis ◽  
Replacement Surgery ◽  
Significant Difference ◽  
Dependent Sample

Precise determination of the size of aortic annulus is very important for thepreoperative evaluation before aortic valve replacement. Objectives: To determine thepreoperative prosthesis size using echocardiography in patients undergoing aortic valvereplacement. Study Design: Prospective observational study. Setting: Ch. Pervaiz ElahiInstitute of Cardiology (CPEIC) Multan. Period: January 2013 to October 2014. Methods: (100patients) Aortic annulus sizes were measured with TTE one week before surgery and with thehelp of sizer per-operatively. The data was analyzed by using SPSS V16. Quantitative variableswere analyzed using mean and standard deviation and percentages were used for qualitativevariables. Dependent sample t test was used to see accuracy of TTE in measuring aortic annulussize. Results: Out of hundred patients, 84(84%) were male. Mean age of the patients was 33.77+13.17 years. 51% patients underwent isolated Aortic valve replacement; redo-operations weredone only in 4% patients. In 96% patient’s mechanical prosthesis was used and in 4% patient’sboiprosthesis was used for valve replacement. We found no significant difference in Aorticannulus measured pre-operatively with the TTE (23.54+ 3.54) and measured per-operativewith the sizer (23.96+3.36) with highly insignificant p-value 0.58.Aortic annulus size was almostsame measured by these two techniques. Conclusion: Aortic annulus size measured with TTEhelps to arrange the optimum size prosthesis before aortic valve replacement surgery.

Abstract 18908: Transcutaneous Aortic Valve Replacement - 30 Day and 1 Year Outcomes Using Conscious Sedation in Patients Stratified by STS Risk Score

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Anitha Rajamanickam ◽  
Sandeep Basnet ◽  
Kaylan Mucci ◽  
Ravinder Rao ◽  
Jimmy Yee ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Conscious Sedation ◽  
Statistical Significance ◽  
Vascular Complications ◽  
The Elderly ◽  
Number Of Patients ◽  
Significant Difference

Introduction: Transcutaneous Aortic Valve Replacement [TAVR] is usually performed under general anesthesia [GA]. We sought to examine the feasibility and safety of monitored conscious sedation [CS] as opposed to GA . METHODS: 196 patients [116 self expanding and 80 balloons expandable] underwent TAVR from December 2010 to August 2012 at our institution. 1 month follow up was completed on all patients and 1 year follow up was available on 105 patients. 39 patients [20%] underwent CS. Only one patient crossed over from CS to GA. We divided the patients into 3 groups [STS <8, STS of 8 to <12, STS ≥ 12 with the primary endpoints of all-cause mortality at 1 month and 1 year [See Table 1] RESULTS: Though the study did not meet statistical significance due to low number of patients, there was a trend towards improved mortality with CS. Also, there was no statically significant difference with regards to procedural complications including periprocedural MI, major bleeding, emergency CABG or major vascular complications. All 5 patients with periprocedural stroke had GA. The CS patients had a shorter length of stay [5 +2.87 days] as compared to GA patients [8 days+7.86 days] CONCLUSION: Use of CS suggested an improved mortality trend in higher risk patients [STS≥ 12]. This is of great importance as complications of GA, most importantly respiratory complications, are higher in the elderly TAVR patients and these can be avoided with CS . Also CS enables us to monitor neurological status during the procedure which is of vital importance given the high rates of stroke with TAVR

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