Single center TAVR experience with a focus on the prevention and management of catastrophic complications

• Published in: Catheterization and cardiovascular interventions Vol. 84; no. 5; pp. 834 - 842
• Main Authors: Kapadia, Samir R., Svensson, Lars G., Roselli, Eric, Schoenhagen, Paul, Popovic, Zoran, Alfirevic, Andrej, Barzilai, Benico, Krishnaswamy, Amar, Stewart, William, Mehta, Anand, lal Poddar, Kanhaiya, Parashar, Akhil, Modi, Dhruv, Ozkan, Alper, Khot, Umesh, Lytle, Bruce W., Murat Tuzcu, E.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.11.2014; Wiley Subscription Services, Inc; BlackWell Publishing Ltd
• Subjects: Academic Medical Centers; Aged; Aged, 80 and over; Aortic Rupture - mortality; Aortic Rupture - prevention & control; aortic stenosis; Aortic Valve - physiopathology; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Cardiology; Cohort Studies; comparative effectiveness/patient centered outcomes research; complications; Coronary Stenosis - prevention & control; Echocardiography, Doppler; Female; Follow-Up Studies; Hospital Mortality; Humans; Kaplan-Meier Estimate; Male; Medical research; Mortality; percutaneous intervention; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Postoperative Complications - prevention & control; Retrospective Studies; Risk Assessment; Rupture, Spontaneous - prevention & control; Severity of Illness Index; Stroke - mortality; Stroke - prevention & control; Survival Rate; TAVR; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - methods; Transcatheter Aortic Valve Replacement - mortality; Treatment Outcome; Valvular and Structural Heart Diseases; vascular access; aortic stenosis; complications; percutaneous intervention; TAVR; comparative effectiveness/patient centered outcomes research; vascular access
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.25356

Background Transcatheter aortic valve replacement (TAVR) is an important treatment option for patients with severe symptomatic aortic stenosis (AS) who are inoperable or at high risk for complications with surgical aortic valve replacement. We report here our single‐center data on consecutive patients undergoing transfemoral (TF) TAVR since the inception of our program, with a special focus on minimizing and managing complications. Methods The patient population consists of all consecutive patients who underwent an attempted TF‐TAVR at our institution, beginning with the first proctored case in May 2006, through December 2012. Clinical, procedural, and echocardiographic data were collected by chart review and echo database query. All events are reported according to Valve Academic Research Consortium‐2. Results During the study period, 255 patients with AS had attempted TF‐TAVR. The procedure was successful in 244 (95.7%) patients. Serious complications including aortic annular rupture (n = 2), coronary occlusion (n = 2), iliac artery rupture (n = 1), and ventricular embolization (n = 1) were successfully managed. Death and stroke rate at 30 days was 0.4% and 1.6%, respectively. One‐year follow‐up was complete in 171 (76%) patients. One‐year mortality was 17.5% with a 3.5% stroke rate. Descending aortic rupture, while advancing the valve, was the only fatal procedural event. There were 24.4% patients with ≥2+ aortic regurgitation. Conclusions TAVR can be accomplished with excellent safety in a tertiary center with a well‐developed infrastructure for the management of serious complications. The data presented here provide support for TAVR as an important treatment option, and results from randomized trials of patients with lower surgical risk are eagerly awaited. © 2014 Wiley Periodicals, Inc.