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Review
. 2022 Jul;37(7):2053-2059.
doi: 10.1111/jocs.16380. Epub 2022 Mar 6.

Minimum requirements in emergency kits for bailout strategies in TAVR complications

Marco Gennari  1 , Gilbert H L Tang  2 , Maurizio Taramasso  3 , Giulio Russo  4 , Philipp K Haager  5 , Marco Barbanti  6 , Ana Paula Tagliari  7 , Francesco Maisano  8
Affiliations
Review

Minimum requirements in emergency kits for bailout strategies in TAVR complications

Marco Gennari et al. J Card Surg. 2022 Jul.

Abstract

Introduction: The proportion of patients with symptomatic severe aortic stenosis treated by transcatheter aortic valve replacement (TAVR) is increasing, driven by favorable outcomes from randomized trials and current valve guidelines recommendations. Despite device and technique improvements having reduced procedural morbidities, complications during or immediately after TAVR still carries significant mortality risk.

Methods: We propose a check-list of essential items to anticipate potentially life-threatening complications in TAVR.

Results: Purpose of this review is to discuss the most common life-threatening complications during TAVR from a troubleshooting perspective, depicting the minimum required equipment needed in emergency situations.

Conclusions: Prevention of complications remains the most important strategy to optimize outcomes in TAVR procedures. Each specialized Center should institute and make easily accessible standardized emergency kits for the most common life-threatening conditions during TAVR that should be readily available in the cath-lab or hybrid operating room.

Keywords: TAVR; bailout; coronary occlusion; vascular complications.

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Conflict of interest statement

Gilbert H.L. Tang: physician proctor for Medtronic; is a consultant for Medtronic, Abbott, and NeoChord; and is an advisory board member for Abbott and JenaValve. Maurizio Taramasso: consultant for Abbott Vascular, Boston Scientific, 4tech, CoreMedic. Speaker fees from Edwards Lifesciences. Francesco Maisano: Grant and/or Research Support from Abbott, Medtronic, Edwards Lifesciences, Biotronik, Boston Scientific Corporation, NVT, Terumo Consulting fees, Honoraria from Abbott, Medtronic, Edwards Lifesciences, Xeltis, Cardiovalve. Royalty Income/IP Rights: Edwards Lifesciences. Shareholder (including share options) of Cardiogard, Magenta, SwissVortex, Transseptalsolutions, Occlufit, 4Tech, Perifect. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1
Figure 1
(A) Emergent pericardiocentesis for acute hemopericardium; the draining Pigtail catheter is inserted within the pericardial sac after fluoroscopic confirmation of the correct needle position by contrast dye injection (arrows). (B) Snaring of a self‐expanding valve implanted too low (too ventricular). (C) Infrainguinal arteriogram showing dissection and extravasation of contrast medium at the end of a TAVR procedure. (D) Ascending aorta dissection (arrow) detected at the post‐deployment angiogram. (E) Left main stenosis (arrow) after transcatheter aortic valve deployment causing ST elevation on electrocardiogram. (F) Self‐expanding prosthesis implantation subsequent ascending aorta embolization. Final result after second implantation of an Edwards Sapien 3 balloon‐expandable valve
See this image and copyright information in PMC

References

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