No abstract

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.

Paravalvular leak occurs in about 2–3% of patients after surgical valve replacement. The leak may cause heart failure, arrhythmias, or hemolysis. Patients who have had multiple operations or who have significant comorbidity constituting a contraindication to surgery might be considered candidates for transcatheter closure. In the past, occluding paravalvular leaks has been attempted using coils or double umbrella devices; defect specific devices are under development. Interventional experiences with various Amplatzer occluders are described.

New catheter techniques and a large variety of endovascular devices permit transcatheter treatment - not only of common atrial or ventricular septal defects - but also of rare intracardiac malformations such as postmyocardial infarction ventricular septal defects, sinus valsalva aneurysm or paravalvular leak. Owing to the variable anatomical nature of paravalvular leaks, closure may be one of the most challenging interventional procedures in the field of structural heart disease. Current literature documents ambiguous results and endorses the limitations of this procedure. In most cases these limitations are technical. Further efforts in the development of defect-specific devices and techniques may result in an improved patient outcome and extended patient selection.