Lambl's excrescence in transcatheter aortic valve implantation: prevalence and risk of embolic events

Abstract

Background: The role of aortic valve Lambl's excrescence (LEs) in determining ischemic events has not been well clarified, but they can represent a potential embolic source during procedures with catheter/device manipulation through the aortic valve. Aim of our study was to assess the prevalence of LEs and the rate of embolism in patients with aortic valve stenosis scheduled for transcatheter aortic valve implantation (TAVI).

Methods: Our population was divided into two groups, named LEs and no-LEs. In each group, the rate of cerebral embolic events was assessed, as well as other TAVI-related complications.

Results: In our study population 28 patients (37%) had aortic strands and 48 (63%) did not have them. A cerebral protection device was used in four patients of LEs group (14% vs. 0, P=0.03). The mean procedural time was similar in the two groups: 50±19 and 55±26 minutes (P=0.38) in LEs and no-LEs groups, respectively. The device success was achieved in 96% of LEs and 88% of no-LEs patients (P=0.37). Two patients of no-LEs group died during the procedure. Major complications were observed in both groups without any significant differences. Only one case of stroke occurred in the population without LEs (0 LEs vs. 2% no-LEs, 0.78). No cases of peripheral embolism were observed.

Conclusions: In our population the observation of LEs is not uncommon. Despite the presumed high risk of embolism, we have not observed an increase in the rate of cerebral ischemic events or other TAVI related complications in patients with LEs.