Corevalve evolut r pro

All TAVR procedures were performed using either the SAPIEN devices (Edwards Lifesciences, Irvine, California) or the CoreValve Evolut R/PRO devices (Medtronic, Minneapolis, Minnesota). Optimal type and size of transcatheter heart valve were determined using preprocedural multidetector CT measurements evaluated with 3mensio Structural Heart software (3mensio Medical Imaging BV, Bilthoven, The Netherlands). Pre-dilatation and post-dilatation were left to the physician’s discretion. During the TAVR procedure, unfractionated heparin was administered to achieve an activated clotting time of 250–300 s. Closure of the vascular access was usually performed using two Perclose ProGlide™ vascular closure systems (Abbott Laboratories, Chicago, IL, USA).

In patients not taking antiplatelet medication, acetylsalicylic acid was started prior to the procedure. Additional clopidogrel was started on the morning of the procedure. Novel oral anticoagulant therapy was discontinued 24 h before the procedure. Oral anticoagulant therapy was continued, aiming for an International Normalised Ratio level of 2–2.5.
All procedures were performed with the patient under conscious sedation. Puncture of the femoral artery was performed with either fluoroscopic or ultrasound guidance. During the procedure, heparin was given and an activated clotting time between 250 and 300 s was targeted. The implanted bioprosthetic valves were either the CoreValve Evolut R/PRO (Medtronic, Minneapolis, MN, USA), the ACURATE neo (Boston Scientific, Natick, MA, USA) or the LOTUS Edge (Boston Scientific). In patients treated with a CoreValve a 16-French (Fr) InLine sheath or a 20-Fr Sentrant introducer sheath was used. In patients treated with an ACURATE neo a 14-Fr iSLEEVE or a small LOTUS introducer sheath was used. A large LOTUS introducer sheath was used for implantation of the LOTUS Edge. After valve implantation, in cases where the activated clotting time was above 200 s, protamine was given before vascular closure.