208Rev Bras Cir Cardiovasc | Braz J Cardiovasc SurgRev Bras Cir Cardiovasc 2013;28(2):208-16 Pontes JCDV, et al. -Initial and pioneer experience of transcatheter aortic valve implantation (Inovare) through femoral or iliac artery RBCCV 44205-1459 DOI: 10.5935/1678 Initial and pioneer experience of transcatheter aortic valve implantation (Inovare) through femoral or iliac artery Abstract Objective: This paper demonstrates the initial and pioneering experience implant of the Inovare prosthesis implant through transfemoral or iliac artery route.Methods: Six patients underwent transcatheter aortic valve implantation. The access was femoral or iliac through which the delivery device, a latex balloon catheter with the crimped prosthesis, was inserted. Through the femoral introducer 24 Fr Gore ® DrySeal sheath, an extra stiff guide wire with non-traumatic tip was positioned in the left ventricle by passing through the valve ring. After balloon valvuloplasty, in cases of native valve stenosis, the prosthesis implantation was performed after hypotension induced by tachycardia and controlled by temporary pacemaker. The valve positioning was guided by TEE (transesophageal ecocardiography) and fluoroscopy, aiming to position a third of the length of the prosthesis into the left ventricle cavity.Results: The successful valve implantation was possible in six cases. There was no need of conversion to open surgery due to inability to access or graft migration. There were no intraoperative or hospital deaths. We observed a significant reduction in the mean gradient of 66.84±15.46 mmHg to 19.74±10.61 mm Hg postoperatively (P=0.002), a reduction of 70.46%.Conclusion: Inovare prosthesis, implanted by femoral or iliac artery was feasible, and determined adequate hemodynamic performance in the postoperative follow-up, showing no mortality in this small series.Descriptors: Heart valve diseases. Stents. Heart catheterization. Heart valve prosthesis implantation/methods. Aortic valve/surgery. ORIGINAL ARTICLE 209Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Bras Cir Cardiovasc 2013;28(2):208- Rev INTRODUCTIONDegenerative calcification of normal or congenital bicuspid aortic valve is the leading cause of aortic valve stenosis in adults in developed countries [1][2][3]. Prevalence of severe aortic stenosis increases with age and may affect up to 2% of individuals over 65 years of age [4]. The onset of symptoms constitutes poor prognosis and survival after that is as low as 60% in 1 year and 32% in 5 years [5]. Death in patients with heart failure usually occurs 2 years after the onset of symptoms, and after 3 and 5 years for patients with syncope and angina, respectively [6]. In such cases, surgical intervention alters the natural course of the disease, since surgical mortality, at about 4%, is considered low [7]. However, 33% of patients who are candidates for surgical treatment are not accepted to undergo the procedure, especially due to advanced age and ventricular dysfunction [8]. Other conditions, such as associated comorbidit...

We present a patient with severe aortic valvular bioprosthesis dysfunction implanted for 11 years, presenting with acute pulmonary edema due to severe valvular insufficiency with severe systolic dysfunction (EF <30%) and comorbid conditions that amounted operative risk (STS score > 10). We carried out the transcatheter aortic valve implantation (Inovare® -Braile Biomedica), which was implemented successfully by transfemoral access and good patient outcomes.Descriptors: Heart valve prosthesis. Aortic valve/surgery. Heart valve prosthesis implantation. Aortic valve insufficiency. Resumo

Aortic dissection type A has a great mortality in its acute phase with low annual survival without surgical treatment. Although the chronic cases are exceptions the late complications exist and should be treated.