Autopsy after transcatheter aortic valve implantation

Abstract

Autopsy after transcatheter aortic valve implantation (TAVI) is a new field of interest in cardiovascular pathology. To identify the cause of death, it is important to be familiar with specific findings related to the time interval between the procedure and death. We aimed to provide an overview of the autopsy findings in patients with TAVI in their medical history divided by the timing of death with specific interest in the added value of autopsy over a solely clinically determined cause of death. In 8 European centres, 72 cases with autopsy reports were available. Autopsies were divided according to the time interval of death and reports were analysed. In 32 patients who died ≤72 h postprocedure, mortality resulted from cardiogenic or haemorrhagic shock in 62.5 and 34.4%, respectively. In 31 patients with mortality >72 h to ≤30 days, cardiogenic shock was the cause of death in 51.6% followed by sepsis (22.6%) and respiratory failure (9.7%). Of the nine patients with death >30 days, 88.9% died of sepsis, caused by infective endocarditis in half of them. At total of 12 patients revealed cerebrovascular complications. Autopsy revealed unexpected findings in 61.1% and resulted in a partly or completely different cause of death as was clinically determined. Autopsy on patients who underwent TAVI reveals specific patterns of cardiovascular pathology that clearly relate to the time interval between TAVI and death and significantly adds to the clinical diagnosis. Our data support the role of autopsy including investigation of the cerebrum in the quickly evolving era of cardiac device technology.

Prosthetic valve endocarditis after transcatheter aortic valve replacement: A case report and current review

“…[7][8][9] The incidence of clinical PVE after TAVR spans between 0.6% and 3%, [6,[8][9][10] although autopsy studies show a rate closer to 12%. [4] The median age at diagnosis was 80 years. [8,11] Respiratory infections, and dental and urologic procedures were the leading source for bacteremia, [6,9,10,12] though in half of the patients, the source of infections could not be identified.…”

“…Prosthetic valve endocarditis (PVE) after TAVR is a rare but very serious and often deadly complication. [4] Surgical valve replacement (SVR) remains the cornerstone treatment for complicated PVE. However, the patients undergoing TAVR are often elderly and have complex comorbidities which may eventually preclude or substantially increase the risk of SVR.…”

Comparison of hemodynamic and clinical outcomes of transcatheter and sutureless aortic bioprostheses: how to make the right choice in intermediate risk patients

“…Durability in TAVI is related to the biological nature of the valve leaflets and to pre-procedural steps, such as valve crimping and intravalvular balloon inflation, which is essential for a transcatheter delivery. Several reports have been recently published showing specific lesions (transverse fractures and longitudinal cleavages) on pericardial leaflets, especially in balloon-expandable valves (24)(25)(26)(27), phenomena that can potentially lead to valve deterioration. Unfortunately, longterm durability data after TAVI are still not available in the literature and just a few reports present results in patients with 5-year follow-up (28) that, for valve prosthesis, are not considered sufficient.…”

Incidence, Clinical Characteristics, and Impact of Absent Echocardiographic Signs in Patients With Infective Endocarditis After Transcatheter Aortic Valve Implantation

“…[3,7] These distinctive features of TAVI-IE can delay diagnosis and therapy and have even led to postmortem diagnosis only. [12] Recent studies have shown that 18 F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET ) uptake around surgical valves is an accurate indicator of PVE and case series described its applicability in TAVI-IE. [11] However, there are no systematic and large scale data for computed tomography (CT) or ¹⁸F-FDG PET evaluation in patients with suspected TAVI-IE.…”