Valve-Related Complications in TAVI Leading to Emergent Cardiac Surgery

Abstract

Transcatheter aortic valve implantation (TAVI) is now a standard procedure for the treatment of symptomatic aortic valve stenosis in many patients. In Germany, according to the annual reports from the German Institute for Quality Assurance and Transparency in Healthcare (Institut für Qualitätssicherung und Transparenz im Gesundheitswesen), the rate of serious intraprocedural complications, such as valve malpositioning or embolization, coronary obstruction, aortic dissection, annular rupture, pericardial tamponade, or severe aortic regurgitation requiring emergency cardiac surgery has decreased markedly in recent years from more than 5.5% in 2012 to 2.0% in 2019. However, with increased use, the total number of adverse events remains about 500 per year, about 100 of which require conversion to sternotomy. These, sometimes, fatal events can occur at any time and are still challenging. Therefore, the interdisciplinary TAVI heart team should be prepared and aware of possible rescue strategies.

Keywords

transcatheter aortic valve implantation - complications - surgery

Publication History

Received: 24 May 2022

Accepted: 16 September 2022

Article published online:
29 November 2022

• References

• 1 Aortenklappenchirurgie, isoliert (Kathetergestützt): Qualitätsindikatoren und Kennzahlen; Herausgeber IQTIG –Institut für Qualitätssicherung und Transparenz im Gesundheitswesen. 2012–2019. Accessed May 20, 2022, at: www.iqtig.org/veroeffentlichungen/qualitaetsreport/
• 2 Généreux P, Piazza N, Alu MC. et al; VARC-3 WRITING COMMITTEE. Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research. Eur Heart J 2021; 42 (19) 1825-1857
• 3 Bernardi FLM, Rodés-Cabau J, Tirado-Conte G. et al. Incidence, predictor, and clinical outcomes of multiple resheathing with self-expanding valves during transcatheter aortic valve replacement. J Am Heart Assoc 2021; 10 (18) e020682
• 4 Kim WK, Schäfer U, Tchetche D. et al. Incidence and outcome of peri-procedural transcatheter heart valve embolization and migration: the TRAVEL registry (TranscatheteR HeArt Valve EmboLization and Migration). Eur Heart J 2019; 40 (38) 3156-3165
• 5 Arsalan M, Kim WK, Van Linden A. et al. Predictors and outcome of conversion to cardiac surgery during transcatheter aortic valve implantation. Eur J Cardiothorac Surg 2018; 54 (02) 267-272
• 6 Zhang P, Li F, Wang Y. et al. Long-term outcomes of patients with self-expandable transcatheter heart valve embolized in the aorta. Int Heart J 2021; 62 (06) 1265-1272
• 7 Walther T, Hamm CW, Schuler G. et al; GARY Executive Board. Perioperative results and complications in 15,964 transcatheter aortic valve replacements: prospective data from the GARY registry. J Am Coll Cardiol 2015; 65 (20) 2173-2180
• 8 Makkar RR, Jilaihawi H, Chakravarty T. et al. Determinants and outcomes of acute transcatheter valve-in-valve therapy or embolization: a study of multiple valve implants in the U.S. PARTNER trial (Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve). J Am Coll Cardiol 2013; 62 (05) 418-430
• 9 Abramowitz Y, Chakravarty T, Jilaihawi H. et al. Clinical impact of coronary protection during transcatheter aortic valve implantation: first reported series of patients. EuroIntervention 2015; 11 (05) 572-581
• 10 Ribeiro HB, Webb JG, Makkar RR. et al. Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry. J Am Coll Cardiol 2013; 62 (17) 1552-1562
• 11 Ribeiro HB, Nombela-Franco L, Urena M. et al. Coronary obstruction following transcatheter aortic valve implantation: a systematic review. JACC Cardiovasc Interv 2013; 6 (05) 452-461
• 12 Arai T, Lefèvre T, Hovasse T. et al. Incidence and predictors of coronary obstruction following transcatheter aortic valve implantation in the real world. Catheter Cardiovasc Interv 2017; 90 (07) 1192-1197
• 13 Seipelt RG, Hanekop GG, Schoendube FA, Schillinger W. Heart team approach for transcatheter aortic valve implantation procedures complicated by coronary artery occlusion. Interact Cardiovasc Thorac Surg 2012; 14 (04) 431-433
• 14 Rodés-Cabau J, Webb JG, Cheung A. et al. Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience. J Am Coll Cardiol 2010; 55 (11) 1080-1090
• 15 Zierer A, Wimmer-Greinecker G, Martens S, Moritz A, Doss M. The transapical approach for aortic valve implantation. J Thorac Cardiovasc Surg 2008; 136 (04) 948-953
• 16 Holmes Jr DR, Mack MJ, Kaul S. et al. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol 2012; 59 (13) 1200-1254
• 17 Masson JB, Kovac J, Schuler G. et al. Transcatheter aortic valve implantation: review of the nature, management, and avoidance of procedural complications. JACC Cardiovasc Interv 2009; 2 (09) 811-820
• 18 Akinseye OA, Jha SK, Ibebuogu UN. Clinical outcomes of coronary occlusion following transcatheter aortic valve replacement: a systematic review. Cardiovasc Revasc Med 2018; 19 (02) 229-236
• 19 Conzelmann LO, Würth A, Schymik G. et al. Feasibility of transcatheter aortic valve implantation in patients with coronary heights ≤7 mm: insights from the transcatheter aortic valve implantation Karlsruhe (TAVIK) registry. Eur J Cardiothorac Surg 2018; 54 (04) 752-761
• 20 Boukantar M, Gallet R, Mouillet G. et al. Coronary procedures after TAVI with the self-expanding aortic bioprosthesis Medtronic CoreValve™, not an easy matter. J Interv Cardiol 2017; 30 (01) 56-62
• 21 Dvir D, Webb J, Brecker S. et al. Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: results from the global valve-in-valve registry. Circulation 2012; 126 (19) 2335-2344
• 22 Ribeiro HB, Rodés-Cabau J, Blanke P. et al. Incidence, predictors, and clinical outcomes of coronary obstruction following transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: insights from the VIVID registry. Eur Heart J 2018; 39 (08) 687-695
• 23 Dvir D, Leipsic J, Blanke P. et al. Coronary obstruction in transcatheter aortic valve-in-valve implantation: preprocedural evaluation, device selection, protection, and treatment. Circ Cardiovasc Interv 2015; 8 (01) e002079
• 24 Khan JM, Greenbaum AB, Babaliaros VC. et al. The BASILICA trial: prospective multicenter investigation of intentional leaflet laceration to prevent TAVR coronary obstruction. JACC Cardiovasc Interv 2019; 12 (13) 1240-1252
• 25 Smith CR, Leon MB, Mack MJ. et al; PARTNER Trial Investigators. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011; 364 (23) 2187-2198
• 26 Eggebrecht H, Schmermund A, Kahlert P, Erbel R, Voigtländer T, Mehta RH. Emergent cardiac surgery during transcatheter aortic valve implantation (TAVI): a weighted meta-analysis of 9,251 patients from 46 studies. EuroIntervention 2013; 8 (09) 1072-1080
• 27 Thomas M, Schymik G, Walther T. et al. Thirty-day results of the SAPIEN aortic Bioprosthesis European Outcome (SOURCE) registry: a European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve. Circulation 2010; 122 (01) 62-69
• 28 Auffret V, Lefevre T, Van Belle E. et al; FRANCE TAVI Investigators. Temporal trends in transcatheter aortic valve replacement in France: FRANCE 2 to FRANCE TAVI. J Am Coll Cardiol 2017; 70 (01) 42-55
• 29 Zhao ZG, Jilaihawi H, Feng Y, Chen M. Transcatheter aortic valve implantation in bicuspid anatomy. Nat Rev Cardiol 2015; 12 (02) 123-128
• 30 Conzelmann LO, Würth A, Balthasar V. et al. Transcatheter aortic valve implantation in severe calcified annulus using the Lotus valve system: increased incidence of fatal major vascular complications. Catheter Cardiovasc Interv 2020; 95 (01) E21-E29
• 31 Himbert D, Pontnau F, Messika-Zeitoun D. et al. Feasibility and outcomes of transcatheter aortic valve implantation in high-risk patients with stenotic bicuspid aortic valves. Am J Cardiol 2012; 110 (06) 877-883
• 32 Al-Attar N, Himbert D, Barbier F, Vahanian A, Nataf P. Delayed aortic dissection after transcatheter aortic valve implantation. J Heart Valve Dis 2013; 22 (05) 701-703
• 33 Rylski B, Suedkamp M, Beyersdorf F. et al. Outcome after surgery for acute aortic dissection type A in patients over 70 years: data analysis from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg 2011; 40 (02) 435-440
• 34 Cigala E, Monteforte I, Piro O, Monda V, Capozzolo C, Bonzani G. [Lotus Sadra valve implantation complicated by type B aortic dissection: diagnosis and treatment]. G Ital Cardiol (Rome) 2017; 18 (04) 325-328
• 35 Conzelmann LO, Yousef M, Schnelle N. et al. How should I treat a DeBakey type I acute aortic dissection four weeks after transcatheter aortic valve implantation in an old, fragile patient?. EuroIntervention 2015; 10 (12) e1-e6
• 36 Dachille A, Iacovelli F, Giardinelli F. et al. [Acute aortic dissection during ineffective attempt of transcatheter implant of a fully resheathable, respositionable and retrievable aortic valve]. G Ital Cardiol (Rome) 2017; 18 (2, suppl 1): 31S-34S
• 37 Yashima F, Hayashida K, Fukuda K. Delivery balloon-induced ascending aortic dissection: an unusual complication during transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2016; 87 (07) 1338-1341
• 38 Ong SH, Mueller R, Gerckens U. Iatrogenic dissection of the ascending aorta during TAVI sealed with the CoreValve revalving prosthesis. Catheter Cardiovasc Interv 2011; 77 (06) 910-914
• 39 Mwipatayi BP, Picardo A, Masilonyane-Jones TV. et al. Incidence and prognosis of vascular complications after transcatheter aortic valve implantation. J Vasc Surg 2013; 58 (04) 1028-36.e1
• 40 Rezq A, Basavarajaiah S, Latib A. et al. Incidence, management, and outcomes of cardiac tamponade during transcatheter aortic valve implantation: a single-center study. JACC Cardiovasc Interv 2012; 5 (12) 1264-1272
• 41 Baikoussis NG, Argiriou M, Kratimenos T, Karameri V, Dedeilias P. Iatrogenic dissection of the descending aorta: conservative or endovascular treatment?. Ann Card Anaesth 2016; 19 (03) 554-556
• 42 Nagasawa A, Shirai S, Hanyu M, Arai Y, Kamioka N, Hayashi M. Descending aortic dissection injured by tip of the sheath during transcatheter aortic valve implantation. Cardiovasc Interv Ther 2016; 31 (02) 122-127
• 43 Gerber RT, Osborn M, Mikhail GW. Delayed mortality from aortic dissection post transcatheter aortic valve implantation (TAVI): the tip of the iceberg. Catheter Cardiovasc Interv 2010; 76 (02) 202-204
• 44 Conzelmann LO, Weigang E, Mehlhorn U. et al; GERAADA Investigators. Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg 2016; 49 (02) e44-e52
• 45 Hein R, Abdel-Wahab M, Sievert H. et al; German Transcatheter Aortic Valve Interventions Registry Investigators. Outcome of patients after emergency conversion from transcatheter aortic valve implantation to surgery. EuroIntervention 2013; 9 (04) 446-451
• 46 Barbanti M, Yang TH, Rodès Cabau J. et al. Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement. Circulation 2013; 128 (03) 244-253
• 47 Pasic M, Unbehaun A, Dreysse S. et al. Rupture of the device landing zone during transcatheter aortic valve implantation: a life-threatening but treatable complication. Circ Cardiovasc Interv 2012; 5 (03) 424-432
• 48 Pasic M, Unbehaun A, Buz S, Drews T, Hetzer R. Annular rupture during transcatheter aortic valve replacement: classification, pathophysiology, diagnostics, treatment approaches, and prevention. JACC Cardiovasc Interv 2015; 8 (1 Pt A): 1-9
• 49 Hansson NC, Nørgaard BL, Barbanti M. et al. The impact of calcium volume and distribution in aortic root injury related to balloon-expandable transcatheter aortic valve replacement. J Cardiovasc Comput Tomogr 2015; 9 (05) 382-392
• 50 Sá MP, Van den Eynde J, Malin JH, Torregrossa G, Sicouri S, Ramlawi B. Impact of left ventricle outflow tract calcification on the outcomes of transcatheter aortic valve implantation: a study-level meta-analysis. J Card Surg 2022; 37 (05) 1379-1390
• 51 Montalto C, Sticchi A, Crimi G. et al. Outcomes after transcatheter aortic valve replacement in bicuspid versus tricuspid anatomy: a systematic review and meta-analysis. JACC Cardiovasc Interv 2021; 14 (19) 2144-2155
• 52 Eggebrecht H, Vaquerizo B, Moris C. et al; European Registry on Emergent Cardiac Surgery during TAVI (EuRECS-TAVI). Incidence and outcomes of emergent cardiac surgery during transfemoral transcatheter aortic valve implantation (TAVI): insights from the European Registry on Emergent Cardiac Surgery during TAVI (EuRECS-TAVI). Eur Heart J 2018; 39 (08) 676-684
• 53 Deleanu D, Platon P, Chioncel O, Iliescu VA, Parasca CA. Percutaneous closure of Gerbode defect type II post-TAVR with Amplatzer Muscular VSD Occluder. JACC Cardiovasc Interv 2021; 14 (17) e229-e230
• 54 Kappetein AP, Head SJ, Généreux P. et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Am Coll Cardiol 2012; 60 (15) 1438-1454
• 55 Moores DW, Allen KB, Faber LP. et al. Subxiphoid pericardial drainage for pericardial tamponade. J Thorac Cardiovasc Surg 1995; 109 (03) 546-551 , discussion 551–552
• 56 Athappan G, Patvardhan E, Tuzcu EM. et al. Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: meta-analysis and systematic review of literature. J Am Coll Cardiol 2013; 61 (15) 1585-1595
• 57 Hahn RT, Kodali S, Généreux P, Leon M. Paravalvular regurgitation following transcutaneous aortic valve replacement: predictors and clinical significance. Curr Cardiol Rep 2014; 16 (05) 475
• 58 Kaneko H, Hoelschermann F, Tambor G, Yoon SH, Neuss M, Butter C. Predictors of paravalvular regurgitation after transcatheter aortic valve implantation for aortic stenosis using new-generation balloon-expandable SAPIEN 3. Am J Cardiol 2017; 119 (04) 618-622
• 59 Webb JG, Doshi D, Mack MJ. et al. A randomized evaluation of the SAPIEN XT transcatheter heart valve system in patients with aortic stenosis who are not candidates for surgery. JACC Cardiovasc Interv 2015; 8 (14) 1797-1806
• 60 Meredith Am IT, Walters DL, Dumonteil N. et al. Transcatheter aortic valve replacement for severe symptomatic aortic stenosis using a repositionable valve system: 30-day primary endpoint results from the REPRISE II study. J Am Coll Cardiol 2014; 64 (13) 1339-1348
• 61 Yang TH, Webb JG, Blanke P. et al. Incidence and severity of paravalvular aortic regurgitation with multidetector computed tomography nominal area oversizing or undersizing after transcatheter heart valve replacement with the SAPIEN 3: a comparison with the SAPIEN XT. JACC Cardiovasc Interv 2015; 8 (03) 462-471
• 62 Kalogeras K, Ruparelia N, Kabir T. et al. Comparison of the self-expanding Evolut-PRO transcatheter aortic valve to its predecessor Evolut-R in the real world multicenter ATLAS registry. Int J Cardiol 2020; 310: 120-125
• 63 Rück A, Kim WK, Kawashima H. et al. Paravalvular aortic regurgitation severity assessed by quantitative aortography: ACURATE neo2 versus ACURATE neo transcatheter aortic valve implantation. J Clin Med 2021; 10 (20) 4627
• 64 Schymik G, Herzberger V, Bergmann J. et al. Evolution of transcatheter aortic valve implantation over 7 years: results of a prospective single-centre registry of 2000 patients in a large municipal hospital (TAVIK Registry). BMJ Open 2018; 8 (10) e022574
• 65 Nombela-Franco L, Rodés-Cabau J, DeLarochellière R. et al. Predictive factors, efficacy, and safety of balloon post-dilation after transcatheter aortic valve implantation with a balloon-expandable valve. JACC Cardiovasc Interv 2012; 5 (05) 499-512
• 66 Eggebrecht H, Doss M, Schmermund A, Nowak B, Krissel J, Voigtländer T. Interventional options for severe aortic regurgitation after transcatheter aortic valve implantation: balloons, snares, valve-in-valve. Clin Res Cardiol 2012; 101 (06) 503-507
• 67 McInerney A, Vera-Urquiza R, Tirado-Conte G. et al. Predilation and post-dilation in transcatheter aortic valve replacement: indications, benefits and risks. Interv Cardiol 2021; 16: e28
• 68 Wunderlich NC, Honold J, Swaans MJ, Siegel RJ. How to image and manage prosthesis-related complications after transcatheter aortic valve replacement. Curr Cardiol Rep 2021; 23 (08) 94
• 69 Abdel-Wahab M, Zahn R, Horack M. et al; German transcatheter aortic valve interventions registry investigators. Aortic regurgitation after transcatheter aortic valve implantation: incidence and early outcome. Results from the German transcatheter aortic valve interventions registry. Heart 2011; 97 (11) 899-906
• 70 Zahn R, Gerckens U, Grube E. et al; German Transcatheter Aortic Valve Interventions-Registry Investigators. Transcatheter aortic valve implantation: first results from a multi-centre real-world registry. Eur Heart J 2011; 32 (02) 198-204
• 71 Sinning JM, Hammerstingl C, Vasa-Nicotera M. et al. Aortic regurgitation index defines severity of peri-prosthetic regurgitation and predicts outcome in patients after transcatheter aortic valve implantation. J Am Coll Cardiol 2012; 59 (13) 1134-1141
• 72 Gotzmann M, Korten M, Bojara W. et al. Long-term outcome of patients with moderate and severe prosthetic aortic valve regurgitation after transcatheter aortic valve implantation. Am J Cardiol 2012; 110 (10) 1500-1506
• 73 Adams DH, Popma JJ, Reardon MJ. et al; U.S. CoreValve Clinical Investigators. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med 2014; 370 (19) 1790-1798
• 74 Kodali SK, Williams MR, Smith CR. et al; PARTNER Trial Investigators. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 2012; 366 (18) 1686-1695
• 75 Hahn RT, Pibarot P, Stewart WJ. et al. Comparison of transcatheter and surgical aortic valve replacement in severe aortic stenosis: a longitudinal study of echocardiography parameters in cohort A of the PARTNER trial (placement of aortic transcatheter valves). J Am Coll Cardiol 2013; 61 (25) 2514-2521
• 76 Ando T, Briasoulis A, Telila T, Afonso L, Grines CL, Takagi H. Does mild paravalvular regurgitation post transcatheter aortic valve implantation affect survival? A meta-analysis. Catheter Cardiovasc Interv 2018; 91 (01) 135-147
• 77 Pibarot P, Hahn RT, Weissman NJ, Monaghan MJ. Assessment of paravalvular regurgitation following TAVR: a proposal of unifying grading scheme. JACC Cardiovasc Imaging 2015; 8 (03) 340-360
• 78 Pibarot P, Hahn RT, Weissman NJ. et al. Association of paravalvular regurgitation with 1-year outcomes after transcatheter aortic valve replacement with the SAPIEN 3 valve. JAMA Cardiol 2017; 2 (11) 1208-1216
• 79 Eggebrecht H, Mehta RH, Kahlert P. et al. Emergent cardiac surgery during transcatheter aortic valve implantation (TAVI): insights from the Edwards SAPIEN Aortic Bioprosthesis European Outcome (SOURCE) registry. EuroIntervention 2014; 10 (08) 975-981
• 80 Li F, Wang X, Wang Y. et al. Short- and long-term outcome after emergent cardiac surgery during transcatheter aortic valve implantation. Ann Thorac Cardiovasc Surg 2021; 27 (02) 112-118
• 81 Ibebuogu UN, Giri S, Bolorunduro O. et al. Review of reported causes of device embolization following trans-catheter aortic valve implantation. Am J Cardiol 2015; 115 (12) 1767-1772
• 82 Kobo O, Saada M, Roguin A. Can transcatheter aortic valve implantation [TAVI] be performed at institutions without on-site cardiac surgery department?. Cardiovasc Revasc Med 2022; 41: 159-165
• 83 Minimum volumes for TAVI: Better prospects of success with larger case volumes. (July 28, 2021). Accessed on May 24, 2022 at: www.iqwig.de/en/presse/press-releases/press-releases-detailpage_43840.html
• 84 Seiffert M, Conradi L, Baldus S. et al. Severe intraprocedural complications after transcatheter aortic valve implantation: calling for a heart team approach. Eur J Cardiothorac Surg 2013; 44 (03) 478-484 , discussion 484
• 85 Smith CR. Emergency cardiac surgery following TAVI: implications for the future. Eur Heart J 2018; 39 (08) 685-686
• 86 Griese DP, Reents W, Kerber S, Diegeler A, Babin-Ebell J. Emergency cardiac surgery during transfemoral and transapical transcatheter aortic valve implantation: incidence, reasons, management, and outcome of 411 patients from a single center. Catheter Cardiovasc Interv 2013; 82 (05) E726-E733
• 87 Grube E, Buellesfeld L, Mueller R. et al. Progress and current status of percutaneous aortic valve replacement: results of three device generations of the CoreValve Revalving system. Circ Cardiovasc Interv 2008; 1 (03) 167-175
• 88 Laricchia A, Mangieri A, Latib A. et al. Temporal trends in procedural death and need for urgent open surgery during transcatheter aortic valve replacement: a single, high-volume center 10-year experience. Int J Cardiol 2019; 293: 80-83
• 89 Pepe M, Corcione N, Biondi-Zoccai G. et al. Comparison of outcomes of transcatheter aortic valve implantation in patients ≥85 years versus those <85 years. Am J Cardiol 2020; 129: 60-70
• 90 Piazza N, Grube E, Gerckens U. et al. Procedural and 30-day outcomes following transcatheter aortic valve implantation using the third generation (18 Fr) CoreValve revalving system: results from the multicentre, expanded evaluation registry 1-year following CE mark approval. EuroIntervention 2008; 4 (02) 242-249