PATIENT BOOKLET. Medtronic Transcatheter Aortic Valve Replacement (TAVR) System. medtronic.com/tavr

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1 PATIENT BOOKLET Medtronic Transcatheter Aortic Valve Replacement (TAVR) System medtronic.com/tavr

2 IS THE MEDTRONIC TAVR VALVE RIGHT FOR YOU? The Medtronic TAVR valve is for people with severe aortic stenosis (AS) and are at high risk or greater risk for surgical aortic valve replacement. Your doctor can help you decide if this device is right for you. This booklet will help you learn more about the Medtronic TAVR valve. medtronic.com/tavr

3 Table of Contents About the Heart...1 Aortic Stenosis...3 Treatment Options for Your Severe Aortic Stenosis...4 Treatment of Your Severe Aortic Stenosis Using a Medtronic TAVR Valve...5 Understanding the Medtronic TAVR Procedure...6 After the Medtronic TAVR Procedure...8 Benefits and Risks...10 Warnings and Precautions...11 Frequently Asked Questions (FAQs)...13 Medtronic TAVR Clinical Trials...14 Other Potential Risks...18 Resources...Back Cover

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About the Heart 1 How the Heart Works A healthy heart beats around 100,000 times a day. The heart s job is to supply the body with oxygen-rich blood. The heart has four chambers.

5 About the Heart 1 How the Heart Works A healthy heart beats around 100,000 times a day. The heart s job is to supply the body with oxygen-rich blood. The heart has four chambers. Blood is pumped through the four chambers with the help of four heart valves. Left Upper Chamber (Left Atrium) Pulmonary Valve Right Upper Chamber (Right Atrium) Tricuspid Valve Aortic Valve Mitral Valve Left Lower Chamber (Left Ventricle) Right Lower Chamber (Right Ventricle)

Any trouble in this normal flow will make it hard for the heart to pump the blood where it needs to go.

6 About the Heart 2 What Heart Valves Do Heart valves open when the heart pumps to allow blood to flow. They close quickly between heartbeats to make sure blood does not flow backward. Any trouble in this normal flow will make it hard for the heart to pump the blood where it needs to go. The pulmonic valve controls the flow of blood to the lungs to get oxygen The aortic valve controls the flow blood as it exits the heart and is pumped to the rest of the body. The mitral and tricuspid valves control blood flow as it moves between the chambers of the heart medtronic.com/tavr

Severe Aortic Stenosis 3 Severe Aortic Stenosis (Severe AS) of Your Native Valve Your native valve is the valve you were born with. Severe AS occurs when your aortic valve does not open as it should.

7 Severe Aortic Stenosis 3 Severe Aortic Stenosis (Severe AS) of Your Native Valve Your native valve is the valve you were born with. Severe AS occurs when your aortic valve does not open as it should. This makes your heart work harder to pump blood through your body. This affects your health and limits your normal daily activities. Severe AS may be caused by the following: Age Calcium buildup that narrows the aortic valve Radiation therapy Infection of the heart Left untreated, severe AS can lead to heart failure or even sudden death. Failing Surgical Aortic Valve Some people have had their own valve replaced with surgery. Surgical valves wear out over time. The surgical valve can start to fail. The Medtronic TAVR valve might be an option for these people. Signs of Severe Aortic Stenosis Severe AS may cause you to feel: Chest pain Faint Dizzy Tired Out of breath Irregular heart beat Normal Valve Stenotic Valve

8 Treatment Options for Your Severe Aortic Stenosis 4 Medication and Balloon Valvuloplasty (BAV) Your doctor may give you medicine to help ease the symptoms of your disease. A procedure called BAV may also be done. BAV is not surgery. This is where a balloon is placed in the aortic valve and inflated. This may help the valve function better, but is only a temporary fix. Without valve replacement you could feel worse over time. Surgical Aortic Valve Replacement (SAVR) SAVR is an option for some people with severe AS. The native valve is removed and replaced with a new valve. SAVR often includes the following: Your chest is opened to access the heart. Your heart is stopped. A machine pumps blood through your body. Your diseased valve is removed. The new valve is sewn into place. You may be in the hospital for more than a week. The risks of SAVR are listed on pages medtronic.com/tavr

Treatment of your Severe Aortic Stenosis using the Medtronic TAVR System 5 Medtronic Transcatheter Aortic Valve Replacement The Medtronic TAVR valve is another option for people with severe AS.

It is designed to work like your own heart valve. The Medtronic TAVR valve is recapturable, allowing your doctor to accurately position your new heart valve.

9 Treatment of your Severe Aortic Stenosis using the Medtronic TAVR System 5 Medtronic Transcatheter Aortic Valve Replacement The Medtronic TAVR valve is another option for people with severe AS. It does not require open heart surgery. It is implanted using an artery that leads to the heart. The Medtronic TAVR valve is made from pig heart tissue. This tissue valve is held by a metal frame. It is designed to work like your own heart valve. The Medtronic TAVR valve is recapturable, allowing your doctor to accurately position your new heart valve. Your physician may refer to your heart valve by a few different names including CoreValve, Evolut R or Evolut PRO. These are all Medtronic TAVR valves and your doctor can help you decide which is best for you. Metal frame (nickel-titanium alloy) Three tissue leaflets and outer wrap (made from pig heart tissue) Image is bigger than actual valve. Image shown is Evolut PRO Valve.

Understanding the TAVR Procedure 6 How Does the Medtronic TAVR Valve Get to My Heart? The arteries in your body are like a system of roads. They branch out from the heart.

10 Understanding the TAVR Procedure 6 How Does the Medtronic TAVR Valve Get to My Heart? The arteries in your body are like a system of roads. They branch out from the heart. There are different routes that your doctor can use to get to your heart. These include: An artery in your leg 1 An artery in your neck 2 A space between your ribs 3 Or another entry point determined by your doctor Each route has risks. Discuss them with your doctor medtronic.com/tavr

7 A Typical Medtronic TAVR Valve Procedure 1. Because each patient is different, your doctor will determine if you should be fully asleep during the 1-2 hour procedure. 2.

Your doctor will place the Medtronic TAVR valve in position within your own diseased heart valve or your failing surgical valve. (Figures 1 and 2) 4.

11 7 A Typical Medtronic TAVR Valve Procedure 1. Because each patient is different, your doctor will determine if you should be fully asleep during the 1-2 hour procedure. 2. The doctor will make a cut and guide a long tube (sheath) into your artery. 3. Your doctor will place the Medtronic TAVR valve in position within your own diseased heart valve or your failing surgical valve. (Figures 1 and 2) 4. Your new Medtronic TAVR valve will begin opening and closing. (Figure 3) The doctor will conduct a test to confirm it is working properly. 5. The thin, flexible tube will be removed, the cut will be closed, and the operation will be complete. During the procedure, your doctor will use machines that use sound waves or x-rays to look at your heart and arteries. Figure 1 Catheter with Compressed Valve Figure 2 Valve Starting to Expand Figure 3 Valve Fully Expanded

After the Medtronic TAVR Procedure 8 Follow-up Care When you leave the hospital your doctor will give you care instructions. You may have to limit certain activities.

12 After the Medtronic TAVR Procedure 8 Follow-up Care When you leave the hospital your doctor will give you care instructions. You may have to limit certain activities. You will need to take medicine and have your heart checked from time to time. Talk to your doctor any time you have questions or concerns about your new heart valve. If you require an MRI* scan, tell the doctor that you have a Medtronic TAVR valve. Tell your doctor if you have a Medtronic TAVR valve inside a surgical valve. Not doing so could result in injury or death. Your dentist and all doctors need to know about your valve. You will get a card with your TAVR heart valve information. Keep this card with you. Show it to any doctors who may be treating you. If you do not get a card, contact your doctor. The lifespan of the Medtronic TAVR valve will vary from patient to patient. It has been tested to mimic 5 years of use without failure. Keep appointments with your doctor. Follow all care instructions to ensure the best possible results. Hospital Stay You will stay in the hospital until your doctor decides you are able to leave. Patients are often walking in a day or two. *Magnetic Resonance Imaging medtronic.com/tavr

The Medtronic TAVR System Benefits and Risks 9 Benefits You should start feeling better right away. This is because your heart valve is now working properly.

13 The Medtronic TAVR System Benefits and Risks 9 Benefits You should start feeling better right away. This is because your heart valve is now working properly. Some patients may take longer to feel better. Most patients felt less pain and less anxious. They could take care of themselves better and go back to everyday activities. If you are interested, ask your doctor for more information on additional clinical studies. Risks Most medical procedures have risks. The Medtronic TAVR procedure s most serious risks are: Death Stroke Serious damage to the arteries Serious bleeding

14 The Medtronic TAVR Procedure is Not Right for Everyone 10 The Medtronic TAVR Valve Should NOT be Used for the Following People: Patients who: Have an infection Have a mechanical valve Cannot take blood thinning medicines Have a reaction to some metals Have a reaction to some imaging solutions If the Medtronic TAVR valve is used in the patients mentioned above, it may not work properly. This could make you feel very sick or even cause death. For some patients, the risk of the Medtronic TAVR procedure may outweigh the benefits. See page 9 for the risks and benefits associated with the Medtronic TAVR procedure. medtronic.com/tavr

15 Warnings and Precautions 11 Warnings Some patients may have a disease that results in more calcium in their blood. This may cause early wear. The Medtronic TAVR valve is only for certain patients. This includes patients with severe AS or failing surgical valves that: Cannot have surgery Are at high risk for surgery Precautions At some point the Medtronic TAVR valve may need to be replaced. How long it lasts varies from patient to patient. It has been tested to mimic 5 years of use without failure. Keep appointments with your doctor. Follow all care instructions to ensure the best possible results. Antibiotics are recommended for patients who are at risk of infections. Patients should stay on blood-thinning medicines after the procedure as instructed. Patients who do not, are more likely to have a stroke. If you require an MRI scan, tell the doctor that you have a Medtronic TAVR valve. Tell your doctor if you have a Medtronic TAVR valve inside a surgical valve. Not doing so could result in injury or death. Your dentist and all doctors need to know about your Medtronic TAVR valve. The Medtronic TAVR valve has not been studied in patients: Who are not sick from AS Who are children With an aortic valve that has only one or two leaflets Who have a blood clot With an abnormal growth in the heart or arteries Who have an infection Who have AS in their own valve and a condition that allows blood to leak backwards through the aortic valve Who have severe mitral valve disease With poor left ventricle function Whose diseased valve is too small or too big Whose arteries are too small for the device Whose arteries that deliver blood to the heart may be blocked by the device Whose arteries that deliver blood to the heart need to be treated Whose arteries that deliver blood to the brain need to be treated Who have severe problems with bleeding or blood clotting Who have specific types of surgical valves implanted in the pulmonary valve Who have specific types of surgical valves implanted in the mitral valve Who have thick heart muscles making it difficult for the heart to pump blood Who have thick heart muscles that blocks the heart from pumping blood If the Medtronic TAVR valve is used in these patients, it may not work right. This could make you feel sick or cause death. For some, the risks of the Medtronic TAVR valve procedure may outweigh the benefits. See page 9 for the risks and benefits.

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17 FAQs 13 Frequently Asked Questions Q) Are physical activities safe? A) Discuss this with your doctor. They can help decide what is best for you. Q) Is it safe to have an x-ray with a Medtronic TAVR valve? A) Yes. The a Medtronic TAVR valve is safe for x-rays. Q) Is it safe to have a MRI with a Medtronic TAVR valve? A) Yes, under certain conditions. If you require an MRI scan, tell the doctor that you have a Medtronic TAVR valve. Tell your doctor if you have a Medtronic TAVR heart valve inside a surgical valve. Not doing so could result in injury or death. Q) How will I know if my Medtronic TAVR valve is working right? A) Attend regular follow-up doctor visits to check your valve.

18 Clinical Studies 14 Medtronic TAVR System Clinical Studies The Medtronic TAVR heart valve has been tested in many studies.the results of 2 studies are summarized on pages The Evolut R System Study and the Evolut PRO System Study. Ask your doctor for more information on the clinical studies on the following patient groups: High Risk Patients Extreme Risk Patients Failing Surgical Valve Patients Severe Renal Disease Patients Low-Flow/Low-Gradient (LFLG) Patients. Evolut R System Study Overview These patients were at high risk or were too sick for surgery. This group included 166 patients at 24 hospitals in the US, Australia, New Zealand and the United Kingdom. Patients were seen at 30 days and 1 year. Yearly checkups will continue for 5 years. The Evolut R valve works like the previous generation CoreValve valve. The CoreValve TAVR System study results at 1 year showed: The CoreValve procedure was a safe and effective alternative to surgery. More CoreValve heart valve patients were alive than surgical patients. Quality of Life Improvements A standard tool* was used to assess health at 30 days. Most Evolut R valve patients: Felt less pain Had improved health Were less anxious Could take care of themselves better Went back to everyday activities The improvement in the patients was similar to the first generation Medtronic TAVR valve patients at 1 year. * This quality of life tool is called the Kansas City Cardiomyopathy Questionnaire (KCCQ) medtronic.com/tavr

19 Evolut R Patients Risks You Should Know 15 What are the Potential Risks 30 Days or 1 Year After an Evolut R System Procedure? Most medical procedures have risks. The Evolut R procedure s most serious risks are: Death Stroke Serious damage to the arteries Serious bleeding Potential risks at 30 days are listed in the table. Almost all received the Evolut R heart valve through a leg artery. This is a common access site. Few used the space between their ribs or an artery in the neck. These sites are not often used. Therefore the results are grouped together. Access site is selected by your doctor. Talk to your doctor about these risks. Evolut R System Clinical Study Outcomes Risks Within 30 Days Risks Within 1 Year Death from any cause 1 out of 100 Patients 8 out of 100 Patients Death from a heart related cause 1 out of 100 Patients 7 out of 100 Patients All stroke 4 out of 100 Patients 6 out of 100 Patients New permanent device to help regulate the heart (pacemaker) 16 out of 100 Patients 19 out of 100 Patients Major vascular access site complication 7 out of 100 Patients 7 out of 100 Patients Heart attack 1 out of 100 Patients 1 out of 100 Patients Valve inflammation or infection (endocarditis) 0 out of 100 Patients 0 out of 100 Patients

16 Evolut PRO System Study Overview These patients were at high risk or were too sick for surgery. This group included 45 patients at 8 hospitals in the US.

20 16 Evolut PRO System Study Overview These patients were at high risk or were too sick for surgery. This group included 45 patients at 8 hospitals in the US. Patients were seen at: 30 days Patients will be seen at: 6 months 1 year Yearly checkups will continue for 5 years. The Evolut PRO valve works like the previous generation CoreValve and Evolut R heart valves. It was also found reasonably safe and effective. Quality of Life Improvements A standard tool* was used to assess health at 30 days. Most Evolut PRO valve patients: Felt less pain Had improved health Were less anxious Could take care of themselves better Went back to everyday activities * This quality of life tool is called the Kansas City Cardiomyopathy Questionnaire (KCCQ) medtronic.com/tavr

21 Evolut PRO Patients Risks You Should Know 17 What are the Potential Risks 30 Days After Evolut PRO valve? Most medical procedures have risks. The Evolut PRO procedure s most serious risks are: Death Stroke Serious damage to the arteries Serious bleeding Potential risks at 30 days are listed in the table. Almost all received the Evolut PRO valve through a leg artery. This is a common access site. Few used the space between their ribs or an artery in the neck. These sites are not often used. Therefore the results are grouped together. Access site is selected by your doctor. Talk to your doctor about these risks. Evolut PRO System Clinical Study Outcomes Risks Within 30 Days Death from any cause Death from a heart related cause All stroke New permanent device to help regulate the heart (pacemaker) Major vascular access site complication Heart attack Valve inflammation or infection (endocarditis) 2 out of 100 Patients 2 out of 100 Patients 0 out of 100 Patients 11 out of 100 Patients 9 out of 100 Patients 0 out of 100 Patients 0 out of 100 Patients

22 Other Potential Risks Associated with Medtronic TAVR System Procedures 18 Cardiogenic shock - failure of the heart to pump enough blood to the body organs Perforation of the myocardium or vessel - a hole in the heart muscle or a blood vessel Cardiac Tamponade - the constriction or inability of the heart to pump due to buildup of blood or fluid around the lining of the heart Ascending aorta trauma - injury to the large blood vessel leading blood away from the heart Embolism - an abnormal particle (air, blood clots) floating in the blood stream or attached to an object, including the valve Thrombosis (including valve thrombosis) - blood clot, including a blood clot on the valve Valve migration - upward or downward movement of the device from where it was originally placed Dysfunctions of a Medtronic TAVR valve including but not limited to: - Break (fracture) in the valve frame - Bending of the valve frame - Valve frame does not open (expand) all the way - Buildup of calcium on the valve - Pannus - the formation of scar tissue that may cover or block the valve from functioning normally - Wear, tear or movement forward (prolapse) or backward (retraction) from the normal position of the valve leaflets - Valve leaflets do not close together - A break in the stitches (sutures) of the valve frame or leaflets - Leakage through or around the valve or valve frame - Incorrect size of the valve implanted - Incorrect position of the valve, either too high or too low - Regurgitation - backward flow of blood through the valve - Stenosis - narrowing of the opening of the valve medtronic.com/tavr

23 19 Mitral valve regurgitation - blood leaking backwards through the valve between the left lower chamber of the heart to the left upper chamber of the heart Hypotension or hypertension - low or high blood pressure Unfavorable reaction by the body (allergic reaction) to: - Antiplatelet agents - blood thinning medicines that keep blood clots from forming - Contrast medium - a substance used to increase the visualization of body structures such as x-ray dye Bowel ischemia - decreased blood supply to the intestines Complications at the area where the doctor cut the skin or related to cutting the skin, including but not limited to: - Pain - Bleeding - Hematoma - blood collecting under the skin - Pseudoaneurysm - blood collecting on the outside of a vessel wall causing a balloon-like widening - Irreversible nerve damage - permanent damage to nerves - Compartment syndrome - squeezing of nerves and muscles in a closed space that could cause muscle or nerve damage - Stenosis - narrowing of a blood vessel (artery) In addition, you may experience other problems that have not been previously observed with this procedure.

24 Resources For More Information on the Medtronic TAVR Procedure Please contact your doctor or nurse for more information. For product information, visit For Technical Support Information Toll-free phone number in the USA: Phone number from outside the USA: address: Caution: Federal law (USA) restricts this device to sale by or on the order of a physician. Medtronic TAVR systems have been approved by FDA for specific patient populations only. Refer to the Instructions for Use for a full list of warnings, precautions, indications, and adverse events. 710 Medtronic Parkway Minneapolis, MN USA Tel: (763) Fax: (763) Toll-free: (800) Medtronic.com/TAVR LifeLine CardioVascular Technical Support Tel: (877) Tel: (763) Fax: (763) rs.cstechsupport@medtronic.com 2017 Medtronic. All rights reserved. Medtronic, Medtronic logo and Further, Together are trademarks of Medtronic. All other brands are trademarks of a Medtronic company. UC EN 01/2017

THE MEDTRONIC TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) SYSTEM

THE MEDTRONIC TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) SYSTEM 1 A Guide for Patients With Severe Aortic Stenosis medtronic.com/tavr Table of Contents 2 3 We have created this booklet to help you learn