Incidence and outcome of peri-procedural transcatheter heart valve embolization and migration: the TRAVEL registry (TranscatheteR HeArt Valve EmboLization and Migration)

Abstract

Aims Peri-procedural transcatheter valve embolization and migration (TVEM) is a rare but potentially devastating complication of transcatheter aortic valve implantation (TAVI). We sought to assess the incidence, causes, and outcome of TVEM in a large multicentre cohort. Methods and results We recorded cases of peri-procedural TVEM in patients undergoing TAVI between January 2010 and December 2017 from 26 international sites. Peri-procedural TVEM occurred in 273/29 636 (0.92%) TAVI cases (age 80.8 ± 7.3 years; 53.8% female), of which 217 were to the ascending aorta and 56 to the left ventricle. The use of self-expanding or first-generation prostheses and presence of a bicuspid aortic valve were independent predictors of TVEM. Bail-out measures included repositioning attempts using snares or miscellaneous tools (41.0%), multiple valve implantations (83.2%), and conversion to surgery (19.0%). Using 1:4-propensity matching, we identified a cohort of 235 patients with TVEM (TVEMPS) and 932 patients without TVEM (non-TVEMPS). In the matched cohort, all-cause mortality was higher in TVEMPS than in non-TVEMPS at 30 days (18.6% vs. 4.9%; P < 0.001) and after 1 year (30.5% vs. 16.6%; P < 0.001). Major stroke was more frequent in TVEMPS at 30 days (10.6% vs. 2.8%; P < 0.001), but not at 1 year (4.6% vs. 1.9%; P = 0.17). The need for emergent cardiopulmonary support, major stroke at 30 days, and acute kidney injury Stages 2 and 3 increased the risk of 1-year mortality, whereas a better renal function at baseline was protective. Conclusion Transcatheter valve embolization and migration occurred in approximately 1% and was associated with increased morbidity and mortality.

New advances in the prevention of transcatheter aortic valve implantation failure: current and future perspectives

“…According to the consensus, the definition of BVF is adverse events are the use of self -expanding or first -generation prostheses and the presence of a bicuspid aortic valve. 22 More frequent and more severe PVR has been reported after TAVI than after surgical aortic valve replacement (SAVR) with a rate of incidence ranging from 1% to 3% for moderate PVR to 29% to 36% for mild PVR. 23 In the PARTNER (Placement of Aortic Transcatheter Valve) trial, 24 at 1-year follow -up, the worsening of PVR was found to be associated with a significant increase in mortality and hospitalizations.…”

Unique technical challenges in patients undergoing TAVR for failed aortic homografts

“…Despite these precautions, two patients with TAVR‐H developed late PVL and ultimately, proximal device migration. Device migration should be a clinical rarity 21 that occurs primarily perioperatively with an incidence of approximately 1% 22 . The use of self‐expanding, first‐generation, and resheathable devices, higher cover index, sizing error, larger aortic root dimensions, and the presence of bicuspid aortic valve all predispose to device migration, but were not the cause of migration in our two patients.…”

A novel technique to manage transcatheter aortic valve embolization

“…Considered a relatively safe procedure, valve embolization during TAVR is a fairly uncommon phenomenon. According to the TranscatheteR HeArt Valve EmboLization and Migration (TRAVEL) registry, valve embolization occurred in 273 of 29,636 patients (0.92%), 2 similar to other registries placing this risk at about 1% 3,4 . It is possible, however, that the prevalence of embolization is actually higher due to possible under‐reporting.…”