Delayed transcatheter heart valve migration and failure

Managing complications after transcatheter aortic valve implantation

INTRODUCTION

Although transcatheter aortic valve implantation (TAVI) has become a streamlined and standardized procedure, different complications still remain and need the operators to be properly trained about their management.

AREAS COVERED

This review article aims at offering a practical overview of the most impactful TAVI complications, analyzing, and discussing the potential risk factors, and focusing on the available strategies for their management.

EXPERT OPINION

Complications following TAVI have been decreasing thanks to technical advancements and operators experience. The thorough knowledge of potential complications and their prevention played a key role in the decreasing of complications rates. Pre-procedural, computed tomography angiography assessment of patient's anatomical characteristics, allows to properly choose and tailor the best strategy for managing complications in most of cases. Nevertheless, further research is required to shed lights about the optimal strategies to adopt for managing TAVI complications.

Aortic Valve Bioprostheses: Leaflet Immobility and Valve Thrombosis

Leaflet immobility and valve thrombosis have been reported with both transcatheter and surgical aortic valve bioprostheses. The relationships between these abnormalities and their incidence, time course, clinical significance, predisposing factors, optimal imaging modality, and current therapeutic options remain uncertain but are rapidly evolving. Four-dimensional computerized tomographic imaging has been determined to have the highest sensitivity in studies evaluating leaflet immobility and valve thrombosis. Echocardiography is also used during surveillance, but it appears to be less sensitive. The definitive diagnosis of valve thrombosis is based on a combination of diagnostic 4-dimensional computerized tomographic imaging findings, resolution of imaging abnormalities, and elevated transcatheter gradients with anticoagulation or surgical or pathological confirmation. Uncertainty about the incidence and clinical significance of the findings is the basis of 2 US Food and Drug Administration-approved studies comparing transcatheter and surgical aortic valve replacement with a subset undergoing surveillance 4-dimensional computerized tomographic imaging. Given the expansion of transcatheter aortic valve procedures, including potentially lower-risk patients, the resolution of these uncertainties is critical.