1
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Hiruma T, Higuchi R, Saji M, Takamisawa I, Shimokawa T, Nanasato M. Transcatheter aortic valve replacement-related aortic dissection: A clinical case series. Catheter Cardiovasc Interv 2023; 101:668-675. [PMID: 36701398 DOI: 10.1002/ccd.30574] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/18/2022] [Accepted: 01/15/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVES We review our experience with 13 periprocedural aortic dissection (AD) cases caused by transcatheter aortic valve replacement (TAVR). BACKGROUND AD is a potentially lethal complication of TAVR; however, only sporadic case reports have been published to date. METHODS Among 1335 consecutive patients who underwent TAVR in 2013-2021, we retrospectively extracted 13 patients (1.0%) with TAVR-related AD (Stanford type A in 6 [46%], type B in 7 [54%]). AD was defined as a new-onset dissected layer of the aortic wall and diagnosed by aortography, computed tomography, or transesophageal echocardiography. RESULTS Five of the six type A AD cases (83%) were detected during TAVR versus only one of the seven type B AD cases (14%). Four of the seven type B AD cases (57%) were asymptomatic and incidentally detected on computed tomography. The presumed causes of AD were injury by the delivery sheath (39%), delivery catheter (23%), valve implantation (15%), stent edge (15%), and pre-dilation balloon (8%). Complicated AD occurred in only one patient (8%). Considering the patient's age and prohibitive surgical risk, all patients were treated conservatively and free of any aortic-related deaths or interventions during a follow-up of 1087 days. CONCLUSIONS TAVR-related AD is a rare but life-threatening condition that may be underdiagnosed. Its optimal therapy remains unclear, and conservative management might be an option for selected patients. Further studies are needed to elucidate the incidence, risk factors, effective screening, optimal therapy, and outcomes of TAVR-related AD.
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Affiliation(s)
- Takashi Hiruma
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
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2
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Manevich L, Landes U, Gluzman Y, Welt M, Rubinshtein R, Danenberg HD. Thoracic Aorta Perforation Treated Conservatively After TAVR in a Patient With Extremely Tortuous Aorta. JACC Case Rep 2023; 5:101691. [PMID: 36523949 PMCID: PMC9745652 DOI: 10.1016/j.jaccas.2022.101691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/05/2022] [Indexed: 06/17/2023]
Abstract
Aortic perforation is a rare complication of transcatheter aortic valve replacement associated with grim outcomes. Tortuous and calcified aortas increase the risk of aortic trauma and perforation. We report a case in which, despite massive thoracic bleeding, avoidance of thoracic aortic surgery resulted in clinical recovery. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Lisa Manevich
- Address for correspondence: Dr Lisa Manevich, Department of Cardiology, E. Wolfson Medical Center, Holon and Tel-Aviv University, Tel-Aviv 5822012, Israel.
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Kuhelj D, Langel Č, Bunc M, Kšela J. Abdominal Stent-Graft Treatment of Ascending Aortic Pseudoaneurysm Following Transcatheter Aortic Valve Implantation. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010016. [PMID: 36676640 PMCID: PMC9863755 DOI: 10.3390/medicina59010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
An ascending aortic pseudoaneurysm is a potentially lethal complication in aortic procedures. We present a hybrid approach using surgical innominate artery access and the endovascular insertion of an abdominal stent-graft extension to successfully treat a zone 0 ascending aortic pseudoaneurysm in a patient with a prior valve-in-valve transcatheter aortic valve implantation.
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Affiliation(s)
- Dimitrij Kuhelj
- Institute of Radiology, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
- Correspondence: ; Tel.: +386-1-522-85-30
| | - Črt Langel
- Institute of Radiology, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Matjaž Bunc
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
- Department of Cardiology, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
| | - Juš Kšela
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
- Department of Cardiovascular Surgery, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
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4
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Useini D, Beluli B, Christ H, Schlömicher M, Ewais E, Patsalis P, Haldenwang P, Naraghi H, Moustafine V, Bechtel M, Strauch J. Transapical transcatheter aortic valve implantation in patients with aortic diseases. Eur J Cardiothorac Surg 2021; 59:1174-1181. [PMID: 33709139 DOI: 10.1093/ejcts/ezab050] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/07/2020] [Accepted: 12/18/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Patients scheduled for transcatheter aortic valve implantation (TAVI) treatment frequently present with concomitant aortic diseases, in which case they are usually considered to be at high interventional risk and, in particular, unable to undergo the transfemoral TAVI approach. Since the establishment of the 'transfemoral first' strategy for TAVI, there has been an evidence gap with regard to the outcomes of such patients. We aimed to evaluate the mid-term outcomes after transapical TAVI in patients with diverse aortic diseases. METHODS Fifty-five consecutive elderly patients (78.4 years; standard deviation: 8.6 years) at intermediate surgical risk with severe aortic stenosis and aortic diseases (porcelain aorta 36%, ascending aneurysm 15%, descending aneurysm 26%, type-B dissection 4%, aortic thrombus 7%, Leriche syndrome 4%, aortic kinking 11%, aortic ulcer 2%, previous aortic operation 20%, aortic elongation/tortuosity 4%) underwent transapical TAVI treatment between January 2011 and November 2019 at our institution. We used the second-and third-generation self- and balloon-expanding valves. The follow-up time was 92.6 patient-years. RESULTS The Society of Thoracic Surgery-Predicted Risk of Mortality score was 7% (standard deviation: 4%). The 30-day mortality and all-stroke rates were 6% and 4%, respectively. The median survival time was 24.9 months (95% confidence interval 17.6-32.3). The median time of freedom from a composite of death and cardio-cerebral adverse events was 24.3 months (95% confidence interval 11.9-36.8). The rate of moderate/severe paravalvular leakage was 2%. The pacemaker rate was 10%. No early or late aortic syndrome occurred. CONCLUSIONS Transapical TAVI is a safe method and shows very promising early and mid-term outcomes, without early/late aortic syndrome, in patients with aortic diseases for whom transfemoral TAVI as the first-line transcatheter method might be contraindicated or not feasible.
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Affiliation(s)
- Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Blerta Beluli
- Department of Internal Medicine, St. Anna Hospital, Herne, Germany
| | - Hildegard Christ
- Department of Medical Statistics, Institute of Medical Statistics and Computational Biology (IMSB), University Hospital of Cologne, Cologne, Germany
| | - Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Elias Ewais
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Polykarpos Patsalis
- Department of Cardiology and Angiology, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Peter Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Hamid Naraghi
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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5
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Useini D, Beluli B, Christ H, Strauch J. Impact of diverse aortic pathologies on outcomes after transapical transcatheter aortic valve replacement. J Card Surg 2021; 36:2240-2246. [PMID: 33783007 DOI: 10.1111/jocs.15516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/05/2021] [Accepted: 03/12/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Some patients who undergo transcatheter aortic valve replacement (TAVR) have a concomitant diverse aortic pathologies (AP). They are usually considered high-risk candidates for the procedure and require further assessment to determine the best vascular approach. The impact of these AP on TAVR is not well known as the information is scarce. We aimed to evaluate midterm clinical impact of different AP after transapical (TA)-TAVR. METHODS Twenty patients with atherosclerotic/occluding aortic diseases (A/OAD) (porcelain aorta, Leriche Syndrome, penetrating aortic ulcer, and aortic thrombus), 24 patients with aortic morphologic diseases (AMD) (thoracic/abdominal aortic aneurysms, aortic kinking, aortic type B dissection, aortic elongation/tortuosity, and previous aortic intervention), and 11 patients with combined aortic diseases (CAD) underwent TA-TAVR treatment between January 2011 and November 2019 at our center. We conducted up to 5-years clinical follow-up. RESULTS All patients were classified in the heart team as a high interventional risk. The 30-day mortality and stroke were 5% and 10% in the A/OAD, 8.3% and 0% in the AMD, and 0% and 0% in the CAD, respectively. The median time of freedom from a composite of death and cardio-cerebral adverse events was 22.1 months [95% confidence interval [CI]: 9.9-34.3] in A/OAD versus 34.3 months [95% CI: 15.6-53] in AMD versus 17 months [95% CI: 0-39.4] in CAD; p = .525. We registered neither procedural aortic injury nor aortic syndrome at follow-up. The moderate/severe paravalvular leakage rates were 5%, 0% and 0% in the A/OAD, AMD and CAD, respectively. CONCLUSION Independent of underlying AP, the TA-TAVR is a safe method and shows very promising early and midterm outcomes in patients with various AP.
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Affiliation(s)
- Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Blerta Beluli
- Department of Internal Medicine, St. Anna Hospital, Herne, Germany
| | - Hildegard Christ
- Department of Medical Statistics, Institute of Medical Statistics and Computational Biology (IMSB), University Hospital of Cologne, Cologne, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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Geile J, Doberentz E, Madea B. Rapid development of an iatrogenic aortic dissection following transcatheter aortic valve implantation. Forensic Sci Med Pathol 2020; 16:335-339. [PMID: 32172483 PMCID: PMC8338862 DOI: 10.1007/s12024-020-00219-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2020] [Indexed: 12/19/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) represents a catheter-based and minimally invasive replacement of the aortic valve. TAVI is considered to be a relatively safe procedure and has evolved to a standard procedure in inoperable and high-risk patients with aortic stenosis. We present a case of an octogenarian who died in hospital less than a day after an initially satisfactory TAVI. Cardiologists suspected a combination of cardiogenic and hemorrhagic shock as the cause of death. Autopsy showed rupture of an extensive aortic dissection, which had developed within 24 h after the procedure. The cause of death was eventually defined as internal bleeding due to a rapid two-stage vascular process. The manner of death was considered accidental because an iatrogenic vessel injury beyond the aortic arch was causative for the death. This unusual case highlights the potential for rare, but fatal, complications within the scope of cardiac catheterizations, such as TAVI. Additionally, our findings suggest that these complications need to be recognized in the diagnostic process and management of post-interventional complications.
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Affiliation(s)
- Julian Geile
- Institute of Legal Medicine, University Hospital Bonn, Stiftsplatz 12, 53111, Bonn, Germany.
| | - Elke Doberentz
- Institute of Legal Medicine, University Hospital Bonn, Stiftsplatz 12, 53111, Bonn, Germany
| | - Burkhard Madea
- Institute of Legal Medicine, University Hospital Bonn, Stiftsplatz 12, 53111, Bonn, Germany
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7
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Kaneko U, Kobayashi K, Hachinohe D, Sumino S, Furugen A, Kawamura T, Doi H, Fujita T. Successful Direct Iliac Transcatheter Aortic Valve Implantation to Overcome Significant Tortuosity of the Thoracic Aorta. Korean Circ J 2018; 48:949-950. [PMID: 30238714 PMCID: PMC6158455 DOI: 10.4070/kcj.2018.0129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/27/2018] [Accepted: 07/17/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Umihiko Kaneko
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan.
| | - Ken Kobayashi
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Daisuke Hachinohe
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Satoshi Sumino
- Department of Cardiovascular Surgery, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Azusa Furugen
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Takeshi Kawamura
- Department of Anesthesiology, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Hirosato Doi
- Department of Cardiovascular Surgery, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
| | - Tsutomu Fujita
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
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8
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Omran N, Kvasnak M, Derner M, Cervinka P. Endovascular management of an aortic rupture following transcatheter aortic valve replacement. J Card Surg 2018; 33:631-633. [PMID: 30209832 DOI: 10.1111/jocs.13813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a case of aortic rupture during transcatheter aortic valve replacement (TAVR) managed successfully by urgent stent-graft implantation.
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Affiliation(s)
- Nedal Omran
- Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic
| | - Martin Kvasnak
- Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic
| | - Milos Derner
- Department of Radiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic
| | - Pavel Cervinka
- Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic
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9
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Kilic A, Siki MA, Szeto WY, Bavaria JE, Anwaruddin S, Desai ND. Concomitant Endografting of a Type B Aortic Dissection During Transfemoral Aortic Valve Replacement. Ann Thorac Surg 2017; 103:e223-e224. [DOI: 10.1016/j.athoracsur.2016.08.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/15/2016] [Accepted: 08/19/2016] [Indexed: 11/29/2022]
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10
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Buzzatti N, Mangieri A, Cota L, Ruparelia N, Romano V, Alfieri O, Colombo A, Montorfano M. Use of double stiff wire allows successful transfemoral transcatheter aortic valve implantation through extreme thoracic aorta tortuosity. Circ Cardiovasc Interv 2016; 8:CIRCINTERVENTIONS.114.002331. [PMID: 25794508 DOI: 10.1161/circinterventions.114.002331] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nicola Buzzatti
- From the Cardiac Surgery Department (N.B., O.A.), Interventional Cardiology Department (A.M., L.C., N.R., V.R., A.C., M.M.), San Raffaele Scientific Institute, Milan, Italy; and Interventional Cardiology Department, Imperial College, London, United Kingdom (N.R.).
| | - Antonio Mangieri
- From the Cardiac Surgery Department (N.B., O.A.), Interventional Cardiology Department (A.M., L.C., N.R., V.R., A.C., M.M.), San Raffaele Scientific Institute, Milan, Italy; and Interventional Cardiology Department, Imperial College, London, United Kingdom (N.R.)
| | - Linda Cota
- From the Cardiac Surgery Department (N.B., O.A.), Interventional Cardiology Department (A.M., L.C., N.R., V.R., A.C., M.M.), San Raffaele Scientific Institute, Milan, Italy; and Interventional Cardiology Department, Imperial College, London, United Kingdom (N.R.)
| | - Neil Ruparelia
- From the Cardiac Surgery Department (N.B., O.A.), Interventional Cardiology Department (A.M., L.C., N.R., V.R., A.C., M.M.), San Raffaele Scientific Institute, Milan, Italy; and Interventional Cardiology Department, Imperial College, London, United Kingdom (N.R.)
| | - Vittorio Romano
- From the Cardiac Surgery Department (N.B., O.A.), Interventional Cardiology Department (A.M., L.C., N.R., V.R., A.C., M.M.), San Raffaele Scientific Institute, Milan, Italy; and Interventional Cardiology Department, Imperial College, London, United Kingdom (N.R.)
| | - Ottavio Alfieri
- From the Cardiac Surgery Department (N.B., O.A.), Interventional Cardiology Department (A.M., L.C., N.R., V.R., A.C., M.M.), San Raffaele Scientific Institute, Milan, Italy; and Interventional Cardiology Department, Imperial College, London, United Kingdom (N.R.)
| | - Antonio Colombo
- From the Cardiac Surgery Department (N.B., O.A.), Interventional Cardiology Department (A.M., L.C., N.R., V.R., A.C., M.M.), San Raffaele Scientific Institute, Milan, Italy; and Interventional Cardiology Department, Imperial College, London, United Kingdom (N.R.)
| | - Matteo Montorfano
- From the Cardiac Surgery Department (N.B., O.A.), Interventional Cardiology Department (A.M., L.C., N.R., V.R., A.C., M.M.), San Raffaele Scientific Institute, Milan, Italy; and Interventional Cardiology Department, Imperial College, London, United Kingdom (N.R.)
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11
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Panoulas VF, Montorfano M, Figini F, Spagnolo P, Contri R, Giustino G, Agricola E, Franco A, Latib A, Colombo A. Unanticipated pseudocoarctation highlights the importance of visualizing aortic arch anatomy before transfemoral transcatheter aortic valve implantation. Circ Cardiovasc Interv 2014; 7:631-3. [PMID: 25139090 DOI: 10.1161/circinterventions.114.001510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vasileios F Panoulas
- From the Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy (V.F.P., M.M., F.F., R.C., G.G., E.A., A.F., A.L., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (V.F.P., R.C., G.G., A.L., A.C.); National Heart and Lung Institute, Imperial College London, London, United Kingdom (V.F.P.); and Radiology Department, San Raffaele Scientific Institute, Milan, Italy (P.S.)
| | - Matteo Montorfano
- From the Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy (V.F.P., M.M., F.F., R.C., G.G., E.A., A.F., A.L., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (V.F.P., R.C., G.G., A.L., A.C.); National Heart and Lung Institute, Imperial College London, London, United Kingdom (V.F.P.); and Radiology Department, San Raffaele Scientific Institute, Milan, Italy (P.S.)
| | - Filippo Figini
- From the Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy (V.F.P., M.M., F.F., R.C., G.G., E.A., A.F., A.L., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (V.F.P., R.C., G.G., A.L., A.C.); National Heart and Lung Institute, Imperial College London, London, United Kingdom (V.F.P.); and Radiology Department, San Raffaele Scientific Institute, Milan, Italy (P.S.)
| | - Pietro Spagnolo
- From the Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy (V.F.P., M.M., F.F., R.C., G.G., E.A., A.F., A.L., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (V.F.P., R.C., G.G., A.L., A.C.); National Heart and Lung Institute, Imperial College London, London, United Kingdom (V.F.P.); and Radiology Department, San Raffaele Scientific Institute, Milan, Italy (P.S.)
| | - Rachele Contri
- From the Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy (V.F.P., M.M., F.F., R.C., G.G., E.A., A.F., A.L., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (V.F.P., R.C., G.G., A.L., A.C.); National Heart and Lung Institute, Imperial College London, London, United Kingdom (V.F.P.); and Radiology Department, San Raffaele Scientific Institute, Milan, Italy (P.S.)
| | - Gennaro Giustino
- From the Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy (V.F.P., M.M., F.F., R.C., G.G., E.A., A.F., A.L., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (V.F.P., R.C., G.G., A.L., A.C.); National Heart and Lung Institute, Imperial College London, London, United Kingdom (V.F.P.); and Radiology Department, San Raffaele Scientific Institute, Milan, Italy (P.S.)
| | - Eustachio Agricola
- From the Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy (V.F.P., M.M., F.F., R.C., G.G., E.A., A.F., A.L., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (V.F.P., R.C., G.G., A.L., A.C.); National Heart and Lung Institute, Imperial College London, London, United Kingdom (V.F.P.); and Radiology Department, San Raffaele Scientific Institute, Milan, Italy (P.S.)
| | - Annalisa Franco
- From the Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy (V.F.P., M.M., F.F., R.C., G.G., E.A., A.F., A.L., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (V.F.P., R.C., G.G., A.L., A.C.); National Heart and Lung Institute, Imperial College London, London, United Kingdom (V.F.P.); and Radiology Department, San Raffaele Scientific Institute, Milan, Italy (P.S.)
| | - Azeem Latib
- From the Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy (V.F.P., M.M., F.F., R.C., G.G., E.A., A.F., A.L., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (V.F.P., R.C., G.G., A.L., A.C.); National Heart and Lung Institute, Imperial College London, London, United Kingdom (V.F.P.); and Radiology Department, San Raffaele Scientific Institute, Milan, Italy (P.S.)
| | - Antonio Colombo
- From the Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy (V.F.P., M.M., F.F., R.C., G.G., E.A., A.F., A.L., A.C.); Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (V.F.P., R.C., G.G., A.L., A.C.); National Heart and Lung Institute, Imperial College London, London, United Kingdom (V.F.P.); and Radiology Department, San Raffaele Scientific Institute, Milan, Italy (P.S.).
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12
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Hein R, Abdel-Wahab M, Sievert H, Kuck KH, Voehringer M, Hambrecht R, Sack S, Hauptmann KE, Senges J, Zahn R, Mudra H. Outcome of patients after emergency conversion from transcatheter aortic valve implantation to surgery. EUROINTERVENTION 2014; 9:446-51. [PMID: 23965349 DOI: 10.4244/eijv9i4a73] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS To evaluate: 1) the causes of emergency conversion from transcatheter aortic valve implantation (TAVI) to surgery, 2) procedural settings, and 3) short-term outcome of converted patients. METHODS AND RESULTS The prospective German TAVI registry was used to identify patients who underwent bail-out surgery during TAVI. Additionally, standardised questionnaires were developed and used to assess more detailed periprocedural and postprocedural data. Emergency conversion from TAVI to open cardiac surgery was required in 24 of 1,975 patients (1.2%). Primary conversion causes were aorto-valvular complications (i.e., aortic annulus rupture, aortic perforation, or thoracic aortic dissection). This was followed by prosthesis embolisation, myocardial perforation, severe aortic regurgitation, and coronary obstructions. The mean time interval between abortions of TAVI to surgery was 19 minutes (SD ± 17 min, range 5-80 min). Four of 24 patients (16.7%) died during the initial surgery, seven of 24 (29.2%) within the first 72 hours and the 30-day mortality was 45.8%. The highest mortality was observed in patients with aortic perforation or dissection (4/5, 80%). Mortality rates for other entities were: prosthesis embolisation 40% (2/5), myocardial perforation 50% (2/4), annulus rupture 67% (2/3), severe aortic regurgitation 33% (1/3), and coronary impairment 0% (0/3). CONCLUSIONS Emergency conversion from TAVI to surgery is a rare event carrying a mortality of around 45% after 30 days. Outcome of converted patients with prior injury of aortic, aorto-valvular, or myocardial tissue during TAVI was poor, whereas patients with severe aortic regurgitation and those with coronary complications had a more favourable outcome after 30 days. Collected procedural and outcome data demand on-site cardiac surgery as a prerequisite for TAVI and constant process optimisation efforts regarding such emergency scenarios.
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Affiliation(s)
- Ralph Hein
- Städtisches Klinikum München GmbH, Klinikum Neuperlach, Department of Cardiology, Munich, Germany
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Loeser H, Wittersheim M, Puetz K, Friemann J, Buettner R, Fries JW. Potential complications of transcatheter aortic valve implantation (TAVI)—an autopsy perspective. Cardiovasc Pathol 2013; 22:319-23. [DOI: 10.1016/j.carpath.2013.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 01/09/2013] [Accepted: 01/11/2013] [Indexed: 11/28/2022] Open
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD, Harrington RA, Bhatt DL, Ferrari VA, Fisher JD, Garcia MJ, Gardner TJ, Gentile F, Gilson MF, Hernandez AF, Jacobs AK, Kaul S, Linderbaum JA, Moliterno DJ, Weitz HH. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement: developed in collabration with the American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Failure Society of America, Mended Hearts, Society of Cardiovascular Anesthesiologists, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Thorac Cardiovasc Surg 2012; 144:e29-84. [PMID: 22898522 DOI: 10.1016/j.jtcvs.2012.03.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Généreux P, Head SJ, Wood DA, Kodali SK, Williams MR, Paradis JM, Spaziano M, Kappetein AP, Webb JG, Cribier A, Leon MB. Transcatheter aortic valve implantation: 10-year anniversary part II: clinical implications. Eur Heart J 2012; 33:2399-402. [PMID: 22851655 DOI: 10.1093/eurheartj/ehs223] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has been increasingly recognized as a curative treatment for severe aortic stenosis (AS). Despite important improvements in current device technology and implantation techniques, specific complications still remain and warrant consideration. Vascular complications and peri-procedural neurological events were the first concerns to emerge with this new technology. Recently, significant post procedural para-valvular leak has been shown to be more frequent after TAVI than after surgical aortic valve replacement (SAVR), and its potential association with worse long-term prognostic has raised concerns. In moving toward treatment of lower risk populations, structural integrity and long-term durability of heat valve prosthesis are becoming of central importance. Emerging technologies and newer generations of devices seem promising in dealing with these matters.
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Affiliation(s)
- Philippe Généreux
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY, USA.
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Pasic M, Unbehaun A, Dreysse S, Buz S, Drews T, Kukucka M, D'Ancona G, Seifert B, Hetzer R. Rupture of the Device Landing Zone During Transcatheter Aortic Valve Implantation. Circ Cardiovasc Interv 2012; 5:424-32. [DOI: 10.1161/circinterventions.111.967315] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background—
Iatrogenic damage of different structures of the aortic root, in the region of the so-called “device landing zone,” may occur during transcatheter aortic valve implantation (TAVI). It is mostly considered difficult to treat or even untreatable.
Methods and Results—
We performed a retrospective analysis of the occurrence, clinical presentation, treatment, and outcome of iatrogenic rupture in the device landing zone in a series of 618 consecutive patients who underwent TAVI at our institution between April 2008 and October 2011. The incidence of rupture was 1% (6 patients). The correct diagnosis was established during TAVI procedures in 4 and postmortem in 2 patients. The major sign of the aortic rupture was apparent bleeding in 4 patients and failure of myocardial recovery after valve implantation in 1; it was asymptomatic in 1 patient. The iatrogenic rupture in the region of the device landing zone was treated surgically in 5 patients and only conservatively in the patient without symptoms. When the diagnosis was established correctly during TAVI, only 1 of 4 patients died (25%). The overall mortality rate was 50% (3 of 6 patients died).
Conclusions—
Rupture of different structures in the device landing zone during TAVI is a life-threatening complication that can be treated successfully if it is immediately recognized and adequately managed.
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Affiliation(s)
- Miralem Pasic
- From the Deutsches Herzzentrum Berlin, Berlin, Germany (M.P., A.U., S.D., S.B., T.D., M.K., G.D., R.H.); and the Division of Biostatistics, ISPM, University of Zurich, Zurich, Switzerland (B.S.)
| | - Axel Unbehaun
- From the Deutsches Herzzentrum Berlin, Berlin, Germany (M.P., A.U., S.D., S.B., T.D., M.K., G.D., R.H.); and the Division of Biostatistics, ISPM, University of Zurich, Zurich, Switzerland (B.S.)
| | - Stephan Dreysse
- From the Deutsches Herzzentrum Berlin, Berlin, Germany (M.P., A.U., S.D., S.B., T.D., M.K., G.D., R.H.); and the Division of Biostatistics, ISPM, University of Zurich, Zurich, Switzerland (B.S.)
| | - Semih Buz
- From the Deutsches Herzzentrum Berlin, Berlin, Germany (M.P., A.U., S.D., S.B., T.D., M.K., G.D., R.H.); and the Division of Biostatistics, ISPM, University of Zurich, Zurich, Switzerland (B.S.)
| | - Thorsten Drews
- From the Deutsches Herzzentrum Berlin, Berlin, Germany (M.P., A.U., S.D., S.B., T.D., M.K., G.D., R.H.); and the Division of Biostatistics, ISPM, University of Zurich, Zurich, Switzerland (B.S.)
| | - Marian Kukucka
- From the Deutsches Herzzentrum Berlin, Berlin, Germany (M.P., A.U., S.D., S.B., T.D., M.K., G.D., R.H.); and the Division of Biostatistics, ISPM, University of Zurich, Zurich, Switzerland (B.S.)
| | - Giuseppe D'Ancona
- From the Deutsches Herzzentrum Berlin, Berlin, Germany (M.P., A.U., S.D., S.B., T.D., M.K., G.D., R.H.); and the Division of Biostatistics, ISPM, University of Zurich, Zurich, Switzerland (B.S.)
| | - Burkhardt Seifert
- From the Deutsches Herzzentrum Berlin, Berlin, Germany (M.P., A.U., S.D., S.B., T.D., M.K., G.D., R.H.); and the Division of Biostatistics, ISPM, University of Zurich, Zurich, Switzerland (B.S.)
| | - Roland Hetzer
- From the Deutsches Herzzentrum Berlin, Berlin, Germany (M.P., A.U., S.D., S.B., T.D., M.K., G.D., R.H.); and the Division of Biostatistics, ISPM, University of Zurich, Zurich, Switzerland (B.S.)
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD, Harrington RA, Bhatt DL, Ferrari VA, Fisher JD, Garcia MJ, Gardner TJ, Gentile F, Gilson MF, Hernandez AF, Jacobs AK, Kaul S, Linderbaum JA, Moliterno DJ, Weitz HH. 2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement. Catheter Cardiovasc Interv 2012; 79:1023-82. [DOI: 10.1002/ccd.24351] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD. 2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2012; 93:1340-95. [PMID: 22300625 DOI: 10.1016/j.athoracsur.2012.01.084] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 01/26/2012] [Accepted: 01/26/2012] [Indexed: 12/20/2022]
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol 2012; 59:1200-54. [PMID: 22300974 DOI: 10.1016/j.jacc.2012.01.001] [Citation(s) in RCA: 551] [Impact Index Per Article: 45.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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