Ventricular septum defect after TAVI: Rare but happens

Introduction: In the past years the numbers of transcatheter aortic valve implanation (TAVI) procedures performed have increased exponentially. With increasing numbers even rare complications of this relatively new technique were identified. Aim of this study was to analyze incidence of ventricular septum defect (VSD) after TAVI.

Methods: A total of 510 high risk patients treated by TAVI through our interdisciplinary heart team were analyzed.

Results: 4/510 (0.8%) patients (2 female, EuroSCORE: 20 ± 6%; STSscore: 5 ± 2%) suffering VSD after TAVI (Transfemoral = 3, Transapical = 1) procedure were identified. Three patients had received balloon expandable Edwards Sapien (1), Sapien XT (2) valves and one patient a self expandable valve (Symetis Accurate). In two patients postdilatation was performed due to severe aortic insufficiency during procedure leading to VSD. Postprocedural echocardiography and angiography revealed in a mild VSD in one patient with no further treatment and moderate/severe VSD in three patients. One patient received a second transcatheter valve, which was implanted transapically leading to VSD occlusion. Two patients received conventional aortic valve replacement due to severe aortic regurgitation with patch occlusion of the VSD. In all cases postinterventional echocardiography revealed a sufficient aortic valve prosthesis without VSD. One patient unfortunately died on POD six due to AV-Block III. All other patients survived.

Conclusion: VSD after TAVI is a rare and unusual complication. It seems to be independent from different valve models but may be related to excessive calcifications. Further therapy consisting of a second TAVI procedure or surgical correction is warranted and leads to acceptable outcomes.