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Severe intraprocedural complications after transcatheter aortic valve implantation: calling for a heart team approach

Selected in European Journal of Cardio-Thoracic Surgery by Rylski

References

Authors

M. Seiffert, L. Conradi, S. Baldus, J. Schirmer, S. Blankenberg, H. Reichenspurner, P.Diemert and H. Treede

Reference

Eur J Cardiothorac Surg (2013) 44 (3): 478-484

Published

September 2013

Link

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My Comment

Background

Transcatheter aortic valve implantation (TAVI) is already being employed in >30% of isolated aortic valve replacements in several European countries. The heart-team approach is essential for procedural success. Seiffert et al. sought to delineate intraprocedural complications during TAVI requiring immediate surgical or interventional bailout manoeuvres.

Major findings

  • 458 patients underwent TAVI at a single institution
  • 35 patients (8%) experienced 40 major intraprocedural complications: valve embolization (17%), coronary obstruction (15%), left ventricular wire perforation (13%), severe aortic regurgitation (12%) and aortic root rupture (5%). All complications required emergent percutaneous intervention or sternotomy.
  • Overall 30-day mortality in patients with complications was 31% and in patients requiring surgical conversion mortality was 39%.
  • Mid-term survival after 30 days in patients who survived complications was comparable with survival of patients undergoing uncomplicated TAVI.

My comments

Despite growing experience and increasing applicability of TAVI, this procedure is still associated with a significant potential for serious life-threatening complications that may appear already introperatively. The authors demonstrated a wide spectrum of adverse events managed by a multidisciplinary heart-team who provided surgical, endovascular and interventional expertise. The mortality in patients who suffered complications was high, but not prohibitive in this selected high-risk patients. There is no alternative for the heart-team, which should be established in all centers performing TAVI procedures.

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