T he normal pericardium consists of 2 layers: a fibrous outer layer and a serous inner layer. The pericardial space is enclosed within these 2 layers and normally contains 20 to 50 mL of serous fluid. The pericardium serves a variety of functions. In addition to its mechanical effects on the heart (limiting distention, promoting chamber-coupling interaction, maintaining cardiac geometry, enabling frictionless movement, and serving as a barrier to infection), the pericardium has immunologic, vasomotor, paracrine, and fibrinolytic activities.

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How to cite this article: Depboylu BC, Yazman S, Harmandar B. Complications of transcatheter aortic valve replacement and rescue attempts. Vessel Plus 2018;2:26. http://dx. AbstractAs a novel treatment modality, transcatheter aortic valve replacement (TAVR) is widely used for patients with severe aortic valve stenosis who have high surgical risk worldwide. However, this promising alternative procedure has different types of complication risks including, cerebrovascular events, vascular complications, bleeding, coronary obstruction, myocardial infarction, valve regurgitation, valve malpositioning or migration, conduction disturbances and acute kidney injury which may occur during and/or after the procedure. These complications may be seen up to one third of the patients and some of them may need urgent surgical intervention and may have a higher risk of death. For preventing and overcoming these complications, pre-procedural evaluation of the patient by an effective "heart team" which consists of cardiologists, cardiac surgeons, radiologists and anesthesiologists in equal proportion is needed. Estimating the potential difficulties and complications, deciding the interventions to be performed in case of any complication may increase the success of the procedure and save the patients' lives. In this article, we reviewed the possible complications of the TAVR procedure and described rescue procedures in case of complications, in the context of the literature.

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With the advent of several valve repair techniques, mitral valve repair is now preferred over mitral valve replacement as the treatment of choice for several mitral pathologic conditions. Because annular dilation is a vital component in most cases of chronic mitral regurgitation (MR), annular support is necessary to provide adequate repair and optimum long-term results.1 Annular reinforcement permits shrinking of the dilated annulus, allowing adequate coaptation of the valve leaflets, thereby preventing recurrent dilation

Leriche sendromu olarak bilinen infrarenal aort tıkanıklığı ve at nalı böbreğin birlikteliği son derece nadirdir. Genellikle fonksiyonel renal parankim içeren at nalı böbreğin boynu, cerrahiyi daha da zorlaştırır. Leriche sendromu ve eş zamanlı at nalı böbrek hastalığı olan 52 yaşında erkek hastaya başarılı bir cerrahi onarım yapıldı. İnfrarenal aort, aortoiliyak bifürkasyon, iliyak arterler ve at nalı böbreği eksplore etmek için median insizyon ve transperitoneal yaklaşım kullanıldı. Boyun aortoiliyak bifürkasyonun üzerinde alt kutupları birbirine bağlıyordu. At nalı böbrek ve aksesuvar arterler korunarak, aortoplasti ve aortobifemoral baypas yapıldı. Ameliyat ve ameliyat sonrası dönemler sorunsuzdu. Takibin sekizinci ayında, hasta günlük aktivitelerinde asemptomatik idi.

ÖZTranskateter aort kapak replasmanı, cerrahi için yüksek riskli olan veya cerrahiye uygun olmayan şiddetli aort darlığı olan hastalarda sıklıkla kullanılan bir tedavi yöntemidir. Bu yöntemin nadir, ancak başlıca komplikasyonlarından biri de genellikle girişim sırasında meydana gelen kapak migrasyonudur. Transkateter aort kapak replasmanı öncesi Kalp Ekibinin değerlendirmesi, kurtarma işlemi olarak yapılacaklar listesini belirler. Muhtemel majör komplikasyonların ve girişimsel planların tartışılması, yaşamı tehdit eden transkateter aort kapak replasmanı komplikasyonları olması durumunda, hastanın hayatını kurtarabilir. Bu yazıda, biküspid aort kapaklı düşük riskli bir hastada transkateter aort kapak replasmanı sırasında gelişen kapak migrasyonunun başarılı cerrahi tedavisi sunuldu.Anah tar söz cük ler: Aort darlığı; protez yetmezliği; cerrahi; transkateter aort kapak replasmanı. ABSTRACTTranscatheter aortic valve replacement is a common treatment method for patients with severe aortic stenosis, who are either at high-risk or non-eligible for surgery. One of the rare, but major complications of this method is valve migration, which usually occurs during the intervention. The assessment of the Heart Team before transcatheter aortic valve replacement is determinant for the "to-do list" for the bail-out procedure. Discussion of the possible major complications and interventional plans may save the patient's life in case of life-threatening transcatheter aortic valve replacement complications. Herein, we report a successful surgical management of valve migration occurred during transcatheter aortic valve replacement in a low-risk patient with bicuspid aortic valve.

Background: Biodegradable atrioventricular annuloplasty rings are theoretically more infection resistant due to their intra-annular implantation technique and nonporous structures (monofilament of poly-1,4-dioxanone). The aim of this study was to investigate the infection resistance of a biodegradable annuloplasty ring (Kalangos-Bioring®) in a rat subcutaneous implantation model and to compare it with a commonly used conventional annuloplasty ring (Edwards Physio II®). Methods: This study included 32 Wistar albino rats which were divided into 2 groups according to the implantation of sterile or infected annuloplasty rings as control and study groups. Each animal had 2 implantation pockets (made on the right and left side of the dorsal median line) where 1 cm of the biodegradable annuloplasty ring was implanted into one pocket and 1 cm of the conventional annuloplasty ring was implanted into the other pocket. The infection model was created by topical inoculation of 1 mL Staphylococcus aureus strain (2 × 10⁷ colony-forming units/mL) into the implantation pockets before skin closure. Each group was equally divided into 4 subgroups according to different follow-up schedules. The animals were inspected for local as well as systemic infection signs, and the rings were explanted at weeks 2, 4, 9, and 14 following implantation. Implantation pockets were evaluated macroscopically as well as by histopathological examinations. Microbiological analysis of the explanted implants with surrounding tissue was done by using quantitative sonication method. Results: Conventional ring-implanted pockets showed a more prominent inflammation reaction than the biodegradable ring-implanted pockets, and this characteristic was found to be accentuated with bacterial contamination. The sterile rings did not reveal any positive cultures in either group. The number of positive cultures found in conventional rings contaminated with S. aureus was greater than in the biodegradable ring group (11/16 vs. 2/16 positive cultures, respectively; p = 0.0032). The amounts of growing bacteria in the culture environment were also statistically significantly higher in the conventional ring group (7,175 ± 5,936 vs. 181 ± 130 colony-forming units/mL, respectively; p < 0.0005). Conclusions: This is the first experimental study confirming the theoretical advantage of the infection resistance of the biodegradable annuloplasty ring (Kalangos-Bioring®) when implanted in an active infectious environment. Large animal models mimicking clinical scenarios and clinical comparative studies are needed to verify our results.