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Transcatheter aortic valve implantation: Complications

Authors
Miles Dalby, MD, FRCP, FESC
Vasileios Panoulas, MD, PhD, FESC, MRCP
Section Editor
Stephen JD Brecker, MD, FRCP, FESC, FACC
Deputy Editor
Susan B Yeon, MD, JD, FACC

INTRODUCTION

Aortic valve replacement (AVR) has been the mainstay of treatment of symptomatic severe aortic stenosis. The role of transcatheter aortic valve implantation (TAVI; also known as transcatheter AVR or TAVR) as an alternative to surgical aortic valve replacement (SAVR) is evolving. Through both rapidly increasing clinical experience and progressive improvement in TAVI devices (eg, lower profile systems to reduce vascular complications), TAVI outcomes have improved. Ongoing studies continue to scrutinize the risks of TAVI complications and continuing efforts seek to minimize these risks.  

Complications of TAVI will be considered in this topic commencing with immediate or periprocedural complications, which are usually apparent during or shortly after the procedure and moving to longer-term considerations. This topic will deal with periprocedural complications related to vascular access (including injury at the arterial access site, arterial tree trauma, and problems with vascular closure), valve deployment (including improper positioning, coronary compromise and annular rupture), valve function (including paravalvular leak), organ injury (including stroke, myocardial ischemia/injury, and acute kidney injury), and arrhythmic complications (including high degree heart block and atrial fibrillation) and late complications including aortic regurgitation and prosthetic valve thrombosis.

Indications, clinical outcomes, and procedural management for TAVI are discussed separately. (See "Choice of therapy for symptomatic severe aortic stenosis" and "Transcatheter aortic valve implantation: Periprocedural management".)

PERIPROCEDURAL COMPLICATIONS

Procedural complications include vascular issues (access-related iliofemoral and aortic complications), ventricular wall perforation (free wall or septal), valvular complications (annular rupture, valve malpositioning, mitral dysfunction, and paravalvular aortic regurgitation), arrhythmias (eg, conduction abnormalities and atrial fibrillation), coronary artery occlusion, myocardial infarction, cerebrovascular accident, and death.

Complications that may occur or be detected after the procedure include acute kidney injury, high degree atrioventricular block requiring pacemaker implantation, myocardial injury, vascular (access-site or aortic) complications that went unrecognized during the procedure, tamponade after removal of temporary wire, valve migration or embolization, mitral valve dysfunction, and death.

                                      

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Literature review current through: Jun 2017. | This topic last updated: May 09, 2017.
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