Incidence and Management of CoreValve Dislocation During Transcatheter Aortic Valve Implantation

Abstract

Background-Transcatheter aortic valve implantation is a highly specialized technique offering a new therapeutic option to patients at high risk for conventional surgery. Complications associated with this catheter procedure differ from complications after surgical aortic valve replacement. This is to report incidence, management, and impact on morbidity and mortality of CoreValve dislocation during catheter valve implantation. Methods and Results-Between June 2007 and September 2009, the self-expandable CoreValve prosthesis (Medtronic Inc, Minneapolis, Minn) was implanted in 212 patients through a transarterial (femoral or subclavian) access. Patients with severe aortic stenosis who were at high risk for conventional surgery were included. We observed dislocation of the prosthesis during CoreValve implantation in 21 patients. In 16 cases, the CoreValve could be implanted in the correct annular position after retrieving it and reloading the catheter. In 4 patients, the completely deployed prosthesis had to be placed in the ascending or abdominal aorta before implanting a second one. One patient underwent open surgery. Overall 30-day mortality was 11.0%, 21.5% in the dislocation group and 9.9% in patients without dislocation (Pϭ0.024). Coronary ischemia, stroke, and renal failure occurred more frequently in patients with dislocation, whereas pacemaker dependency did not differ significantly between the groups. Conclusions-CoreValve

Paravalvular Aortic Leak After Transcatheter Aortic Valve Replacement

“…The incidence of CoreValve dislocation ranged from 3% to 10% depending on the series. 33 Similar results have been reported for the Edwards valve 34,35 (4% to 11%). Sherif et al 36 set out to identify anatomic predictors of PVL using angiography in patients undergoing TAVR with the CoreValve: the angle of the left ventricular outflow tract to the ascending aorta as well as the depth of the device in relation to the noncoronary cusps were found to be independent predictors of PVL.…”

Transcatheter Aortic Valve Implantation: State of the Art

“…Management of this complication primarily consists of retrieving the valve in the ascending aorta and reimplanting it. However, patients with this complication had significantly higher rates of stroke, ischemia, or renal failure than did patients whose first implantation was successful (Geisbusch et al, 2010). Although this complication is documented in other papers, this study on the CoreValve reveals it to be quite frequent.…”

“…Dislocation or migration of the valve during implantation is mentioned in several case reports. In a patient population of 212, Geisbusch et al (2010) reported an incidence of 10% dislocation during implantation, while Rhodes-Cabu et al (2010) had a rate of 2%. Management of this complication primarily consists of retrieving the valve in the ascending aorta and reimplanting it.…”

“…For technical considerations, the presence of torturous, severely diseased femoral or subclavian arteries may not be amenable to percutaneous TAVI. When available, some centers use three-dimensional reconstruction of the aortic root to detect calcifications, femoral stenosis, kinking, and aortic dissection (Geisbusch et al, 2010). While helpful, reconstructions are not essential to the screening process.…”

“…This would culminate in increased safety, efficiency, and physician familiarity with the intervention. It is now estimated that over 15,000 patients worldwide have undergone a TAVI procedure (Geisbusch et al, 2010).…”