Comments Surgery:

• Valve can be implated with transfemoral, transapical and transaortic approach for aortic position.
• Valve can be implanted with transapical or transseptal approach for mitral position (valve-in-ring procedure).

Comments Echocardiography:

• Quantification of common paravalvular aortic regugitationchallanging as most common critera fail. Holodiastolic abdominal aortic flow reversal a good sign of significant aortic regurgitation. Alternative: ((Diast. BP - LVEDP)/ Syst. BP)*100; values < 25 indicate relevant MR with reduced 1 year mortality ²
• TEE is best for definition of exact etiology if regurgitation is significant

References:

1. http://www.edwards.com/eu/Products/TranscatheterValves/Pages/sapienxt.aspx
2. Sinning JM et al., Aortic regurgitation index defines severity of peri-prosthetic regurgitation and predicts outcome in patients after transcatheter aortic alve implantation, J Am Coll Cardiol 2012 Mar 27;59(13):1134-41.

* Design Validation Test Protocol 16868: Pulsatile Flow Pressure Drop / Design Validation Test Protocol 17570: Pulsatile Flow Pressure Drop