ABSTRACT
Transcatheter aortic valve implantation, a percutaneous treatment for severe aortic valve stenosis, is increasingly performed worldwide. The pacemaker should be able to perform overdrive pacing which is essential to reduce cardiac output and transvalvular blood flow which are critical during balloon aortic valvuloplasty and valve deployment of the balloon-expandable valve. Minor adjustment may be needed for ideal positioning, but importantly this has to be done before valve implantation. The delivery system with the mounted valve is introduced into the sheath and inserted over the stiff wire. Prior to final valve deployment, the position of the crimped valve in relation to the aortic cusp has to be assessed with aortic root angiogram and adjusted if necessary. The Evolut R features a supra-annular positioning and it has a low delivery profile. Although TTE can provide measurement of the aortic annulus diameter, contemporary measurement by ECG gated CT scan is considered the current gold standard.
