Contato | Braile Biomédica

Patient´s name (initials):

Birth date:

Procedure date:

Sex:

Weight (Kg):

Height (m):

Body surface (m²):

Technical support:

Doctor:

Proctor:

Hospital:

City:

State:

Country:

Medical agreement:

Distributor/Representative:

Surgery:

Treatment of aortic stenosis
Aortic bioprosthesis replacement
Mitral bioprosthesis replacement
Another, describe:

Describe:

Bioprosthesis Replacement

Manufacturer and model:

Date of previous implant:

Date of previous implant

Type of surgery

Elective
Urgency

Local:

Surgery Center
Hemodynamics
Hybrid room

Type of access

Transapical
Transaortic without CPB
Transaortic with CPB
Other, describe:

In case of Transaortic Implantation with extracorporeal circulation, describe:

Extracorporeal circulation time:

Aortic clamping time:

Procedure outcome:

Success
Complications
Procedure interrupted, describe reason

Complications:

Dissection
Urgency Conversion
Pacemaker
Other, describe

Pre-ballooning:

Yes
No

Leakage:

No
Discreet
Moderate
Severe

Effective Area Pre (cm²):

Describe:

Effective Area Post (cm²):

Describe:

Mean Preoperative Pressure Gradient (mmHg):

Describe:

Mean Postoperative Pressure Gradient (mmHg):

Describe:

Preoperative Pressure Gradient Peak (mmHg):

Describe:

Postoperative Pressure Gradient Peak (mmHg):

Describe:

Braile Biomédica

Implant Registration - Inovare Transcatheter Valve

Implant Registration - Inovare Transcatheter Valve

Diameter (mm):

Surgery:

Describe:

Bioprosthesis Replacement

Date of previous implant:

Type of surgery

Local:

Type of access

In case of Transaortic Implantation with extracorporeal circulation, describe:

Extracorporeal circulation time:

Aortic clamping time:

Procedure outcome:

Complications:

Pre-ballooning:

Leakage:

Effective Area Pre (cm²):

Effective Area Post (cm²):

Mean Preoperative Pressure Gradient (mmHg):

Mean Postoperative Pressure Gradient (mmHg):

Preoperative Pressure Gradient Peak (mmHg):

Postoperative Pressure Gradient Peak (mmHg):