Percutaneous Aortic Valves and Imaging

Complications after Transfemoral Transcatheter Aortic Valve Replacement with a Balloon-Expandable Prosthesis: The Importance of Preventative Measures and Contingency Planning

Transcatheter aortic valve replacement (TAVR) with balloon-expandable Edwards-SAPIEN valve was superior to standard therapy in inoperable patients and noninferior to surgical aortic valve replacement in high surgical-risk, but operable patients, with severe symptomatic aortic stenosis in the randomized controlled PARTNER trial. Since the first case of TAVR with a balloon-expandable valve in 2002, several groups have reported their experience with balloon-expandable valves with high-procedural success. In the United States, the balloon-expandable Edwards-SAPIEN valve is the only transcatheter heart valve approved by the FDA for commercial use. Moreover, this is only in high-risk inoperable patients. Despite increasing experience with the TAVR procedure, it can be associated with complications, which can be technically challenging, even for an experienced operator. Complications associated with TAVR include vascular complications, valve malpositioning, regurgitation, embolization, coronary compromise, conduction abnormalities, stroke/transient ischemic attack, acute kidney injury, cardiac tamponade, and hemodynamic collapse. A thorough understanding of the procedure is essential for pre-emptive planning for procedural complications and early identification and management of complications are necessary for procedural success. We hereby review our experience of transfemoral TAVR with balloon-expandable valves, offer practical tips to maximize the likelihood of procedural success, describe pre-emptive strategies to prevent peri-procedural complications and bailout measures to manage them, should they occur. © 2018 Wiley Periodicals, Inc.

Renal Complications in Patients Undergoing Transcatheter Aortic Valve Replacement

Acute kidney injury in hospitalized patients is associated with significantly increased mortality across a broad spectrum of conditions. According to the Society of Thoracic Surgeons database, patients with chronic kidney disease undergoing surgical aortic valve replacement with or without coronary artery bypass grafting had a more than 50% reduction in observed 8-year survival compared with those without chronic kidney disease. Transcatheter aortic valve replacement is an exciting new approach for the treatment of aortic stenosis in high-risk or inoperable patients with severe aortic stenosis. This article discusses the incidence, predictors, impact, and potential avoidance and management strategies of renal dysfunction associated with transcatheter aortic valve replacement.

Transapical angiography in a patient with severe aortic stenosis undergoing transapical transcatheter aortic valve implantation

Transapical transcatheter aortic valve implantation (TA-TAVI) is the method of choice in patients with severe stenosis of the aortic valve, high operative risk, and an adverse peripheral vasculature. The procedure is generally guided by peripheral arterial access angiography. We report on a 71-year-old patient in whom, because of the absence of an alternative peripheral arterial access route, TA-TAVI was supported by the apical insertion of the angiography catheter. This approach was effective and safe, and proper valve deployment was feasible without unexpected procedural complications.