Iatrogenic Ventricular Septal Defect Following Transcatheter Aortic Valve Replacement: A Systematic Review

Abstract

Ventricular septal defects post-TAVR were seen more with balloon expandable valves and with pre-dilation or post-dilation. Percutaneous treatment of the VSD was preferred over open cardiac surgery given the high surgical risk in this patient population. Some, but not all, patients survived TAVR and VSD and had a good prognosis for both patient groups with or without VSD closure.

Percutaneous closure of an iatrogenic ventricular septal defect following transcatheter aortic valve implantation

“…The majority (75%) of post-TAVI VSDs were reported after balloon expandable valves (e.g. Edwards-Sapien devices) and pre-or post-dilatation was performed in most of the cases [1][2][3], also in our case post-dilatation was performed during the TAVI procedure. The iatrogenic VSD following TAVI procedure might be the result of (1) excessive aortic calcification which lacerates the interventricular septum during pre-or post-dilatation of the stenotic aortic valve and/or (2) or direct damage of the intraventricular septum during the post-dilatation of the valve.…”

“…TAVI revolutionized the management of valvular aortic stenosis by providing a safe and efficacious alternative to surgical valve replacement in higher-risk patients. Iatrogenic VSD is a rare complication following conventional surgical valve replacement and transcatheter closure of such defects with various occluder devices is described in the literature [1][2][3][4]. To date only 20 cases of iatrogenic VSD following TAVI procedure are published and only few of them were treated with a transcatheter interventional approach [1][2][3].…”

“…Membraneous ventricular septal defect (VSD) is a recognized but rare complication of surgical valve replacement, but 20 cases have also been described after transcatheter aortic valve implantation (TAVI) [1]. In this report we describe the case of an iatrogenic VSD following transfemoral TAVI procedure, which was successfully closed from a completely retrograde approach.…”

(Interventricular septal defect as a complication of a concomitant aortic valve replacement and aortocoronary bypass surgery)

“…publikovali prehľadovú prácu, ktorá zahŕňa dvadsať pacientov s VSD po TAVI. 11 Autori prezentujú rôznorodosť symptomatológie pacientov od asymptomatických po progresívne srdcové zlyhávanie a čas vzniku ťažkostí od priamej nadväznosti na TAVI až po jeden rok po výkone. Práca taktiež identifi kuje použitie balónom expandabilných chlopní s pre-dilatáciou alebo post-dilatáciou, ako rizikový faktor vzniku VSD po TAVI.…”

Annular Rupture During Transcatheter Aortic Valve Implantation: Predictors, Management and Outcomes

“…A recent systematic review of iatrogenic VSD following TAVI identified 20 patients from 18 case reports. Of these 20 patients, 13 (65 %) were managed conservatively and seven (35 %) required defect closure 48. Among those requiring intervention, percutaneous techniques wereemployed in six and one patient underwent surgery.…”