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. 2013 May 12:2013:956252.
doi: 10.1155/2013/956252. Print 2013.

A review of most relevant complications of transcatheter aortic valve implantation

Siyamek Neragi-Miandoab  1 , Robert E Michler
Affiliations

A review of most relevant complications of transcatheter aortic valve implantation

Siyamek Neragi-Miandoab et al. ISRN Cardiol. .

Abstract

Transcatheter aortic valve implantation (TAVI) has emerged for treating aortic stenosis in patients who are poor candidates for surgical aortic valve replacement. Currently, the balloon-expandable Edwards Sapien valve-which is usually implanted via a transfemoral or transapical approach-and the self-expanding CoreValve ReValving system-which is designed for retrograde application-are the most widely implanted valves worldwide. Although a promising approach for high-risk patients, the indication may be expanded to intermediate- and eventually low-risk patients in the future; however, doing so will require a better understanding of potential complications, risk factors for these complications, and strategies to individualize each patient to a different access route and a specific valve. This paper reviews the most relevant complications that may occur in patients who undergo catheter-based aortic valve implantation.

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Figures

Figure 1
Figure 1
Severe calcifications of femoral and iliac vessels as well as aorta, aortic arch, and annulus, which carry a high risk of vascular complications, embolic stroke, and paravalvular leak. A transapical approach would be safer in this scenario.
Figure 2
Figure 2
Valve-in-valve bailout procedure. (a) and (b) showing the valve-in-valve for Sapien valve and (c) and (d) for CoreValve.
Figure 3
Figure 3
Valve retrieval. A retrieval of CoreValve is possible if the valve is not completely released; however, this maneuver carries a high risk for vascular complications and embolic stroke.
Figure 4
Figure 4
Perforation of left femoral artery and stent placement. A stent placement is easier and faster in presence of a crossover wire in the femoral artery.
Figure 5
Figure 5
The anatomy of aortic valve, aortic root, coronary arteries orifice, and the conduction system. The proximity of coronary orifice and conduction system to the annulus may explain some of the complications of TAVI.
See this image and copyright information in PMC

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