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Barzallo D, Torrado J, Benites-Moya CJ, Sturla M, Echarte-Morales J, Scotti A, Kharawala A, Terre JA, Sugiura T, Wiley J, Goldberg Y, Latib A. Acute Hemodynamic Compromise After Transcatheter Aortic Valve Replacement Due to Dynamic Left Ventricle Obstruction: A Systematic Review. Am J Cardiol 2024; 214:125-135. [PMID: 38103763 DOI: 10.1016/j.amjcard.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/08/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023]
Abstract
Acute hemodynamic compromise after transcatheter aortic valve replacement (TAVR) because of dynamic left ventricle (LV) obstruction (LVO), also known as suicide LV, is an infrequent but severe complication of TAVR that is poorly defined in previous studies. Understanding this complication is essential for its prompt diagnosis and optimal treatment. We conducted a systematic literature review using PubMed, Embase, Web of Science, and Medline databases for studies describing acute hemodynamic compromise after TAVR because of dynamic LVO or suicide LV. Each study was reviewed by 2 authors individually for eligibility, and a third author resolved disagreements. From a total of 506 studies, 25 publications were considered for the final analysis. The majority of patients with this condition were women demonstrating a hypertrophic septum, a small ventricle, and hyperdynamic contractility on pre-TAVR echocardiographic assessment. An intraventricular gradient before TAVR was found in half of the cases. Acute hemodynamic compromise after TAVR because of dynamic LVO manifested mainly as significant hypotension and occurred most often immediately after valve deployment. The LV outflow tract was the most common site of obstruction. Advanced therapies were required in nearly 65% of the cases. In conclusion, acute hemodynamic compromise after TAVR because of dynamic LVO occurred almost invariably in women. Echocardiography before TAVR may offer essential information to anticipate this complication. LV outflow tract obstruction appears to carry the highest risk of developing this phenomenon. Advanced therapies should be promptly considered as a bailout strategy in patients with hemodynamic collapse refractory to medical therapy.
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Affiliation(s)
- Diego Barzallo
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York.
| | - Juan Torrado
- Department of Cardiology, Montefiore Medical Center, Bronx, New York
| | - Cesar Joel Benites-Moya
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Matteo Sturla
- Department of Cardiology, Montefiore Medical Center, Bronx, New York
| | | | - Andrea Scotti
- Department of Cardiology, Montefiore Medical Center, Bronx, New York
| | - Amrin Kharawala
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Juan A Terre
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Tadahisa Sugiura
- Department of Cardiothoracic Surgery, Montefiore Medical Center, Bronx, New York
| | - Jose Wiley
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Ythan Goldberg
- Section of Structural Echocardiography, Department of Cardiology, Lenox Hill Hospital and Western Region, Northwell Health, New York, New York
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, Bronx, New York
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