Catastrophic Cardiac Events During Transcatheter Aortic Valve Replacement

Liang, Yafen; Dhoble, Abhijeet; Pakanati, Adarsh; Zhao, Yelin; Kork, Felix; Ruan, Wei; Markham, Travis; Smalling, Richard W.; Balan, Prakash; Estrera, Anthony L.; Nguyen, Tom C.; Gregorič, Igor D.; Kar, Biswajit; Eltzschig, Holger K.

doi:10.1016/j.cjca.2021.05.002

Cited by 11 publications

(8 citation statements)

References 19 publications

(29 reference statements)

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“…Other more common catastrophic events can be driven by valve malpositioning with device embolization, aortic root disruption, or coronary artery obstruction. 10 As observed in our study, a mispositioning of the valve and pericardial tamponade were the most common reasons for intraprocedural CPR. Within this cohort, significantly more patients were in need for a surgical bailout with either conversion to open heart surgery and circulatory support compared with patients not undergoing intraprocedural CPR.…”

Section: Discussionsupporting

confidence: 68%

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Outcomes and Characteristics of Patients with Intraprocedural Cardiopulmonary Resuscitation during TAVR

Gerfer

Kuhn

Gablac

et al. 2022

Thorac Cardiovasc Surg

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Background Transcatheter aortic valve replacement (TAVR) has become an established alternative to surgical aortic valve replacement (AVR) for higher risk patients. Periprocedural TAVR complications decreased with a growing expertise of implanters. Yet, TAVR can be accompanied by life-threatening adverse events such as intraprocedural cardiopulmonary resuscitation (CPR). This study retrospectively analyzed predictors and outcomes in a cohort of patients from a high-volume center undergoing periprocedural CPR during TAVR. Methods A total of 729 patients undergoing TAVR, including 59 with intraprocedural CPR, were analyzed with respect to peri- and postprocedural outcomes. Results Patients undergoing CPR showed a significantly lower left ventricular ejection fraction (LVEF) and lower baseline transvalvular mean and peak pressure gradients. The systolic blood pressure measured directly preoperatively was significantly lower in the CPR cohort. CPR patients were in a higher need for intraprocedural defibrillation, heart–lung circulatory support, and conversion to open heart surgery. Further, they showed a higher incidence of atrioventricular block grade III , valve malpositioning, and pericardial tamponade. The in-hospital mortality was significantly higher after intraprocedural CPR, accompanied by a higher incidence of disabling stroke, new pacemaker implantation, more red blood cell transfusion, and longer stay in intensive care unit. Conclusion Impaired preoperative LVEF and instable hemodynamics before valve deployment are independent risk factors for CPR and are associated with compromised outcomes. Heart rhythm disturbances, malpositioning of the prosthesis, and pericardial tamponade are main causes of the high mortality of 17% reported in the CPR group. Nevertheless, mechanical circulatory support and conversion to open heart surgery reduce mortality rates of CPR patients.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionsupporting

confidence: 68%

Outcomes and Characteristics of Patients with Intraprocedural Cardiopulmonary Resuscitation during TAVR

Gerfer

Kuhn

Gablac

et al. 2022

Thorac Cardiovasc Surg

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“…Valve embolization seems to be the most important complication leading to cardiac surgery 2 . This was not the case in our local series, where tamponade was the primary reason for seeking surgical bailout as described by Liang et al 11 …”

Section: Discussionmentioning

confidence: 49%

“…3 Valve embolization seems to be the most important complication leading to cardiac surgery. 2 This was not the case in our local series, where tamponade was the primary reason for seeking surgical bailout as described by Liang et al 11 Emergency surgery for TAVR complications has a high reported mortality rate (between 25% and 35% at 1 month) 10,11 but as the procedure represents a rescue situation, the rate is not prohibitive. In addition, the majority of patients analyzed in these studies were patients considered to be at high surgical risk.…”

Section: Discussionmentioning

confidence: 64%

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Emergency bailout surgery saves lives in high‐risk patients with complications after TAVR

Combaret

D’Ostrevy

Innorta

et al. 2022

Journal of Cardiac Surgery

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Introduction With the expansion of the indication for transcatheter aortic valve implantation (TAVR), the value of access to on‐site emergency heart surgery at performing centers needs to be assessed. Aims To evaluate postoperative mortality after surgical rescue post‐TAVR, in a population at high surgical risk. Methods Retrospective analysis of a cohort of patients included in the France‐TAVI registry who had undergone TAVR with the latest generation valves between January 2017 and February 2020. Results Among the 968 patients undergoing TAVR, 6 patients (0.62%) were identified as candidates for surgery: 3 in the peri‐operative context and 3 during hospitalization. Four subjects were managed in a salvage situation, two due to tamponade, one due to aortic dissection, and one due to aortic annulus rupture. One patient died of a delayed aortic annulus rupture and one patient presented a right coronary occlusion which was medically treated. All patients who underwent emergency surgery were discharged alive from the hospital. Conclusions In TAVR patients initially contraindicated for surgery, emergency bailout surgery could be performed successfully with all patients discharged alive. Access to on‐site heart surgery represents a life‐saving resource for TAVR centers.

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Coronary Embolism After Transcatheter Aortic Valve Replacement—Case Series and Review of Literature

Akuka,

Landes,

Manevich

et al. 2023

The American Journal of Cardiology

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Catastrophic Cardiac Events During Transcatheter Aortic Valve Replacement

Cited by 11 publications

References 19 publications

Outcomes and Characteristics of Patients with Intraprocedural Cardiopulmonary Resuscitation during TAVR

Outcomes and Characteristics of Patients with Intraprocedural Cardiopulmonary Resuscitation during TAVR

Emergency bailout surgery saves lives in high‐risk patients with complications after TAVR

Coronary Embolism After Transcatheter Aortic Valve Replacement—Case Series and Review of Literature

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