Transcatheter aortic valve implantation: Overview of complications
- William H Gaasch, MD
William H Gaasch, MD
- Section Editor — Valvular Disease
- Professor of Medicine
- University of Massachusetts Medical School
- Tufts University School of Medicine
- Senior Consultant in Cardiology
- Lahey Clinic
- Stephen JD Brecker, MD, FRCP, FESC, FACC
Stephen JD Brecker, MD, FRCP, FESC, FACC
- Section Editor — Valvular and Aortic Disease
- Chief of Cardiology
- Clinical Academic Group
- St. George's Hospital & University of London
- Gabriel S Aldea, MD
Gabriel S Aldea, MD
- Section Editor — Cardiac Surgery
- Professor of Surgery
- University of Washington
- Section Editors
- Catherine M Otto, MD
Catherine M Otto, MD
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Cardiac Evaluation; Valvular Disease
- Professor of Medicine
- University of Washington
- Donald Cutlip, MD
Donald Cutlip, MD
- Section Editor — Interventional Cardiology
- Professor of Medicine
- Harvard Medical School
- Beth Israel Deaconess Medical Center
Aortic valve replacement (AVR) has been the mainstay of treatment of symptomatic severe aortic stenosis (AS). The role of transcatheter aortic valve implantation (TAVI; also known as transcatheter aortic valve replacement or TAVR) as an alternative to surgical aortic valve replacement (SAVR) is evolving. A multidisciplinary team approach is recommended in approaching patients with symptomatic AS.
This topic will review complications of TAVI . Indications for AVR and TAVI, surgical AVR, estimating the risk of aortic valve surgery, medical therapy of symptomatic AS, and percutaneous aortic valvuloplasty are discussed separately. (See "Indications for valve replacement in aortic stenosis in adults" and "Choice of therapy for symptomatic severe aortic stenosis" and "Choice of prosthetic heart valve for surgical replacement" and "Estimating the mortality risk of valvular surgery" and "Medical management of symptomatic aortic stenosis" and "Percutaneous balloon aortic valvotomy".)
Overview — Complications of transcatheter aortic valve implantation (TAVI) for native aortic valve stenosis include bleeding, shock, and low cardiac output during and following deployment, annular rupture, vascular complications, valve leaflet thrombosis, myocardial injury, heart block, paravalvular aortic regurgitation, stroke, and death.
Complications of valve-in-valve implantation for failed bioprosthetic valve are similar to those for TAVI for native aortic valve stenosis. However, rates of paravalvular regurgitation and need for permanent pacemaker implantation are much lower for valve-in-valve procedures and annulus rupture is not a reported complication of valve-in-valve implantation . Coronary artery obstruction is more frequent with valve-in-valve procedures than with native aortic valve procedures, as discussed below. (See 'Coronary obstruction' below.)
Bleeding — Early and late (30 or more days post-procedure) bleeding complications are frequent after TAVI . However, the risk of periprocedural bleeding for TAVI may be lower than that for surgical AVR (SAVR), as illustrated by the results of the PARTNER I trial (30-day major bleeding rate 22.7 percent for SAVR, 11.3 for transfemoral-TAVI, and 8.8 percent for transapical-TAVI) .
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- Low cardiac output
- - Causes and management
- - Coronary obstruction
- With native aortic valve procedures
- With valve-in-valve procedures
- Stroke and subclinical brain injury
- Annular rupture
- Vascular complications
- Valve leaflet thrombosis
- Myocardial injury
- Heart block
- Post-TAVR aortic regurgitation
- - Paravalvular regurgitation
- - Central regurgitation
- Prosthetic valve endocarditis