1. Medtronic Engager™ Transcatheter Aortic Valve Implantation System Procedure Quick Review And Tips August 2013 Innovating for life. UC201305602a EE Engager is a registered trademark of Medtronic 3F Therapeutics, Inc.

2. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2013. All Rights Reserved. 1. Dilator tip10. Introducer flushing tube 2. Moving cone 11. Control arm retainer sleeve flushing tube 3. Control arm retainer sleeve 12. Commissure post release (Green) button 4. Bioprosthesis retainer with eyelet retention slots 13. Control arm release (Blue) knob 5. Bioprosthesis retainer sleeve 14. Bioprosthesis deployment (Black) knob 6. Outer shaft15. Handle body 7. Bioprosthesis holder 16. Bioprosthesis retainer sleeve flushing tube 8. Bioprosthesis crimper17. Guidewire lumen 9. Transapical introducer tube System Overview

3. Academia Medical Education INTERNATIONAL. CAUTION: For distribution only in markets where Engager ™ is approved. Medtronic, Inc. 2013. All Rights Reserved. 10-Step Implantation Summary 1 - Identify Implanter’s View 2 - Assess & Prepare Implant 1.Implanter’s view aortic root angiogram 2.Prepare LV and pigtail access sites 3.Test pacing lead 4.Place pigtail catheter in NCC 5.Place guidewire through LV apex into descending aorta 6.If BAV performed, use 4 cm balloon length; Balloon diameter 1 mm ≤ MSCT effective diameter 3 - Advance Delivery System 4 - Ensure Correct Rotational Alignment 5 - Release & Position Control Arms 6 - Release Commissure Posts 7- Deploy Bioprosthesis8 - Retract & Close Delivery System 9 - Remove Delivery System 10 - Assessment & Closure 1.Pressure measurements by simultaneous recordings of LV and aortic pressures 2.Aortic root angiography 3.ECG for arrhythmias and/or heart block 4.Remove wire using Judkins 5.Close apex Rotate handle to align the bioprosthesis retainer flat edge with the non-coronary sinus. 1. Rotate blue knob CW (reference arrow on knob) 2. Gently retract delivery system 1.Activate green button 2.Rotate blue knob CW Exert slight back pressure against native valve Rotate black knob CW + 1.Hold introducer in place 2.Retract delivery system until control arm sleeve docks with introducer 3. Use second projection to verify correct position of control arms