scholarly journals How to reduce uncommon but severe transcatheter aortic valve implantation complications: stroke, thrombosis, endocarditis, cognitive decline?

2021 ◽  
Vol 23 (Supplement_E) ◽  
pp. E142-E146
Author(s):  
Francesco Saia ◽  
Mateusz Orzalkiewicz
Keyword(s):  
Aortic Valve ◽  
Cognitive Decline ◽  
Transcatheter Aortic Valve Implantation ◽  
Heart Valves ◽  
Severe Aortic Stenosis ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Valve Thrombosis ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Transcatheter aortic valve implantation has become a valid alternative to surgical aortic valve replacement for patients with symptomatic severe aortic stenosis, regardless of baseline surgical risk. The incidence of periprocedural complications has steadily declined over the years, thanks to technical advancement of transcatheter heart valves, delivery systems, and increased operators’ experience. Beyond the most common periprocedural complications, there are a few uncommon but potentially severe complications that more often occur during follow-up, although they may also arise in the periprocedural phase. Stroke, infective endocarditis, valve thrombosis, and cognitive decline are among them. In this brief review, we describe the incidence, predictive factors, and potential preventive measures for those events.

scholarly journals Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: an updated meta-analysis

2019 ◽  
Vol 40 (38) ◽  
pp. 3143-3153 ◽  
Author(s):  
George C M Siontis ◽  
Pavel Overtchouk ◽  
Thomas J Cahill ◽  
Thomas Modine ◽  
Bernard Prendergast ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Surgical Aortic Valve Replacement ◽  
Surgical Risk ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Aims  Owing to new evidence from randomized controlled trials (RCTs) in low-risk patients with severe aortic stenosis, we compared the collective safety and efficacy of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) across the entire spectrum of surgical risk patients. Methods and results  The meta-analysis is registered with PROSPERO (CRD42016037273). We identified RCTs comparing TAVI with SAVR in patients with severe aortic stenosis reporting at different follow-up periods. We extracted trial, patient, intervention, and outcome characteristics following predefined criteria. The primary outcome was all-cause mortality up to 2 years for the main analysis. Seven trials that randomly assigned 8020 participants to TAVI (4014 patients) and SAVR (4006 patients) were included. The combined mean STS score in the TAVI arm was 9.4%, 5.1%, and 2.0% for high-, intermediate-, and low surgical risk trials, respectively. Transcatheter aortic valve implantation was associated with a significant reduction of all-cause mortality compared to SAVR {hazard ratio [HR] 0.88 [95% confidence interval (CI) 0.78–0.99], P = 0.030}; an effect that was consistent across the entire spectrum of surgical risk (P-for-interaction = 0.410) and irrespective of type of transcatheter heart valve (THV) system (P-for-interaction = 0.674). Transcatheter aortic valve implantation resulted in lower risk of strokes [HR 0.81 (95% CI 0.68–0.98), P = 0.028]. Surgical aortic valve replacement was associated with a lower risk of major vascular complications [HR 1.99 (95% CI 1.34–2.93), P = 0.001] and permanent pacemaker implantations [HR 2.27 (95% CI 1.47–3.64), P < 0.001] compared to TAVI. Conclusion  Compared with SAVR, TAVI is associated with reduction in all-cause mortality and stroke up to 2 years irrespective of baseline surgical risk and type of THV system.

Impact of Mitral Regurgitation on Clinical Outcomes After Transcatheter Aortic Valve Implantation

2016 ◽  
Vol 11 (1) ◽  
pp. 54
Author(s):  
Crochan J O’Sullivan ◽  
◽  
◽  
◽  
◽  
...  
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Clinical Outcomes ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Severe aortic stenosis (AS) and mitral regurgitation (MR) are the two most common valvular lesions referred for surgical intervention in Europe and frequently co-exist. In patients with both severe AS and significant MR referred for surgical aortic valve replacement (SAVR), a concomitant mitral valve intervention is typically performed if the MR is severe, despite the higher associated perioperative risk. The management of moderate MR among SAVR patients is controversial and depends on a number of factors including MR aetiology (i.e., organic versus functional MR), feasibility of repair and patient risk profile. Moderate or severe MR is present in up to one-third of patients undergoing transcatheter aortic valve implantation (TAVI), is mainly of functional aetiology and is typically left untreated. Although data are conflicting, a growing body of evidence suggests that significant MR exerts an adverse effect on both short- and long-term clinical outcomes after TAVI. Moderate or severe MR improves in just over half of patients following TAVI and recent data suggest MR is more likely to improve among patients receiving a balloon-expandable as compared with a self-expandable transcatheter heart valve.

scholarly journals Thromboembolic and Bleeding Complications in Transcatheter Aortic Valve Implantation: Insights on Mechanisms, Prophylaxis and Therapy

2019 ◽  
Vol 8 (2) ◽  
pp. 280 ◽  
Author(s):  
Mark Ranasinghe ◽  
Karlheinz Peter ◽  
James McFadyen
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Bleeding Complications ◽  
Transcatheter Aortic Valve ◽  
Valve Thrombosis ◽  
Haemodynamic Changes ◽  
Thrombotic Complications ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) has emerged as an important alternative to surgical aortic valve repair (SAVR) for patients with severe aortic stenosis. This rapidly advancing field has produced new-generation devices being delivered with small delivery sheaths, embolic protection devices and improved retrieval features. Despite efforts to reduce the rate of thrombotic complications associated with TAVI, valve thrombosis and cerebral ischaemic events post-TAVI continue to be a significant issue. However, the antithrombotic treatments utilised to prevent these dreaded complications are based on weak evidence and are associated with high rates of bleeding, which in itself is associated with adverse clinical outcomes. Recently, experimental data has shed light on the unique mechanisms, particularly the complex haemodynamic changes at sites of TAVI, that underpin the development of post-TAVI thrombosis. These new insights regarding the drivers of TAVI-associated thrombosis, coupled with the ongoing development of novel antithrombotics which do not cause bleeding, hold the potential to deliver newer, safer therapeutic paradigms to prevent post-TAVI thrombotic and bleeding complications. This review highlights the major challenge of post-TAVI thrombosis and bleeding, and the significant issues surrounding current antithrombotic approaches. Moreover, a detailed discussion regarding the mechanisms of post-TAVI thrombosis is provided, in addition to an appraisal of current antithrombotic guidelines, past and ongoing clinical trials, and how novel therapeutics offer the hope of optimizing antithrombotic strategies and ultimately improving patient outcomes.

scholarly journals Annular Rupture During Transcatheter Aortic Valve Implantation: Predictors, Management and Outcomes

2018 ◽  
Vol 13 (3) ◽  
pp. 140 ◽  
Author(s):  
JJ Coughlan ◽  
Thomas Kiernan ◽  
Darren Mylotte ◽  
Samer Arnous ◽  
◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Early Recognition ◽  
Severe Aortic Stenosis ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Novel Technology ◽  
Life Threatening ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) is the treatment of choice in patients with symptomatic severe aortic stenosis who are either inoperable or at high risk for conventional surgical aortic valve replacement. Recent data have also shown favourable outcomes in patients deemed to be at intermediate operative risk, which expands the application of this novel technology. Despite its success, TAVI has been associated with rare life-threatening complications. Of these, aortic annular rupture is considered to be the most devastating. Advances in pre-procedural screening and patient selection have reduced the incidence of annular rupture. When this complication occurs, early recognition and prompt management are essential. This article is intended to provide a comprehensive review of the predictors, management and clinical outcomes of aortic annular rupture.

scholarly journals Alternative Access for Transcatheter Aortic Valve Implantation: Current Evidence and Future Directions

2019 ◽  
Vol 2 (1) ◽  
pp. 23-27 ◽  
Author(s):  
JJ Coughlan ◽  
Thomas J Kiernan ◽  
Samer Arnous
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Clinical Investigation ◽  
Severe Aortic Stenosis ◽  
Current Evidence ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Randomised Controlled ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) is the usual technique for patients with severe aortic stenosis who are at high risk for surgical aortic valve replacement. The transfemoral (TF) route is the most commonly used access type, and significant progress in this procedure has greatly increased the proportion of patients who can undergo it. Not all patients are suitable for TF TAVI, however, so other routes, including transapical, transaortic, subclavian, trans-subclavian/transaxillary, transcarotid and transcaval, may need to be used. Evidence on these routes shows promising results but the majority of this is registry data rather than randomised controlled trials, so TF TAVI remains the safest access route and should be considered for most patients. However, in patients who are unsuitable for TF TAVI, alternative access routes are safe and feasible. The challenges concern choosing the best route, the valve to use and skill of the specialist centre. This article provides a overview of options for alternative vascular access in TAVI, the clinical rationale for using them, current evidence and areas for clinical investigation.

scholarly journals Transcatheter Aortic Valve Implantation in Small Anatomy: Patient Selection and Technical Challenges

2018 ◽  
Vol 13 (2) ◽  
pp. 1 ◽  
Author(s):  
Makoto Nakashima ◽  
Yusuke Watanabe ◽  
◽  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Patient Selection ◽  
Severe Aortic Stenosis ◽  
Vascular Complications ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Low Incidence ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) has become a standard treatment for severe aortic stenosis. Although this technique has reached relative maturity, further optimisation of patient selection and device implantation is essential to improve prognosis. Smaller body size is a predictor of a challenging TAVI procedure due to specific anatomical difficulty and adverse events including annulus rupture, acute coronary obstruction and vascular complications. A newer generation, lower profile TAVI system is useful for patients with smaller anatomy. Moreover, TAVI is superior to surgical aortic valve replacement in patients with a narrowing annulus because this treatement has a low incidence of prosthesis�patient mismatch.

scholarly journals Advancements in Transcatheter Aortic Valve Implantation: A Focused Update

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 711
Author(s):  
Niccolò Ciardetti ◽  
Francesca Ciatti ◽  
Giulia Nardi ◽  
Francesca Maria Di Muro ◽  
Pierluigi Demola ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Pacemaker Implantation ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) has become the leading technique for aortic valve replacement in symptomatic patients with severe aortic stenosis with conventional surgical aortic valve replacement (SAVR) now limited to patients younger than 65–75 years due to a combination of unsuitable anatomies (calcified raphae in bicuspid valves, coexistent aneurysm of the ascending aorta) and concerns on the absence of long-term data on TAVI durability. This incredible rise is linked to technological evolutions combined with increased operator experience, which led to procedural refinements and, accordingly, to better outcomes. The article describes the main and newest technical improvements, allowing an extension of the indications (valve-in-valve procedures, intravascular lithotripsy for severely calcified iliac vessels), and a reduction of complications (stroke, pacemaker implantation, aortic regurgitation).

scholarly journals Impact of Mitral Regurgitation on Clinical Outcomes After Transcatheter Aortic Valve Implantation

2016 ◽  
Vol 11 (1) ◽  
pp. 54 ◽  
Author(s):  
Crochan J O’Sullivan ◽  
◽  
◽  
◽  
◽  
...  
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Clinical Outcomes ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Severe aortic stenosis (AS) and mitral regurgitation (MR) are the two most common valvular lesions referred for surgical intervention in Europe and frequently co-exist. In patients with both severe AS and significant MR referred for surgical aortic valve replacement (SAVR), a concomitant mitral valve intervention is typically performed if the MR is severe, despite the higher associated perioperative risk. The management of moderate MR among SAVR patients is controversial and depends on a number of factors including MR aetiology (i.e., organic versus functional MR), feasibility of repair and patient risk profile. Moderate or severe MR is present in up to one-third of patients undergoing transcatheter aortic valve implantation (TAVI), is mainly of functional aetiology and is typically left untreated. Although data are conflicting, a growing body of evidence suggests that significant MR exerts an adverse effect on both short- and long-term clinical outcomes after TAVI. Moderate or severe MR improves in just over half of patients following TAVI and recent data suggest MR is more likely to improve among patients receiving a balloon-expandable as compared with a self-expandable transcatheter heart valve.

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