Incidence and prognosis of vascular complications after transcatheter aortic valve implantation

ObjectiveTo investigate transcatheter aortic valve implantation (TAVI) feasibility, effectiveness and safety in radiation-induced aortic valve stenosis cases.Methods198 consecutive patients referred for TAVI were prospectively enrolled. They were divided into two groups: patients with a history of chest radiation therapy with suspected radiation-induced valvular disease (RXT) and others with suspected degenerative aortic valve stenosis (NRXT). Procedural, early and mid-term clinical outcomes were compared.ResultsOf the 198 patients enrolled in our study, 9.6% qualified for inclusion in the RXT group. A comparison of baseline characteristics revealed that patients with RXT were younger than patients with NRXT (68.3 vs 82.5 years; p<0.05) and exhibited a lower surgical risk score (Euroscore: 7.1% vs 21.8%; p<0.05) and a higher frequency of hostile thorax and porcelain aorta (52.6% vs 28.5%; p<0.05; 63.2% vs 10.6%; p<0.05, respectively). In both groups, the implantation success rate was high and the 30-day safety end point acceptable (RXT: 94.7% and 83.3%; NRXT: 93.9% and 75.6%, respectively). At 6 months, overall mortality was significantly lower in the RXT group (0% vs 18%; p=0.048).ConclusionsIn patients suffering from radiation-induced aortic valve stenosis and contraindicated for surgery, TAVI is a promising approach, with high feasibility, acceptable risk, low mortality and high clinical effectiveness at mid-term follow-up.

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“…This severe but rare complication is not specific to irradiated patients and may occur in any context. 31 …”

Section: Discussionmentioning

confidence: 99%

Efficacy and follow-up of transcatheter aortic valve implantation in patients with radiation-induced aortic stenosis

et al. 2015

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“…This translational study has important clinical strengths, particularly because of in vivo conditions that are difficult to simulate in humans. Patchy and contiguous infarct has been seen in a variety of diseases (9,30), systemic lupus erythematosus (31), and prosthetic valve placement (32). Further development in the method of MECV measurement in patients can be helpful in characterizing the progression of myocardial diseases toward heart failure (7,9).…”

Section: Discussionmentioning

confidence: 99%

Multidetector CT Measurement of Myocardial Extracellular Volume in Acute Patchy and Contiguous Infarction: Validation with Microscopic Measurement

Jablonowski

Wilson

Do³

et al. 2015

Radiology

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“…Mwipatayi et al, 9 in a single-center study reported on 100 TAVR patients recruited during the 3-year period (2009-2012). Overall, 81 of their patients underwent transfemoral approach and 18 transapical.…”

Section: Discussionmentioning

confidence: 99%

Vascular Complications Associated with Transfemoral Aortic Valve Replacement

et al. 2015

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Background?Transfemoral aortic valve replacement (TAVR) is a novel technique for treating aortic stenosis, yet vascular complications are yet to be delineated. Objectives?This study aims to study the vascular complications of TAVR with Edwards Sapien valves (Edwards Lifesciences Corp., Irvine, CA). Methods?We performed a retrospective evaluation of TAVR patients. Standard demographics, femoral vessel and sheath size, access type (femoral cut-down [FC], percutaneous access [PFA], and iliac conduit [IC]), and treatment method were recorded. Complications were defined by the Valve Academic Research Consortium Criteria. Logistic regression was used for statistical analysis. Results?A total of 99 patients underwent TAVR between February 15, 2012 and July 17, 2013 with an Edwards Sapien valve. Out of which, 48 were males with a mean age of 83???7 years. Overall, 33 had FC, 58 had PFA, and 6 had an IC. A total of 17 major (2 aortic and 15 iliac) and 38 minor complications (36 access and 2 emboli) occurred. Aortic complications were managed by open repair (OR, 1) or percutaneous repair (PR, 1). Overall, 12 iliac injuries were managed by PR and 3 by OR. Out of the 33 groin complications in FC patients 8 (24%) were treated by OR, whereas 30 (52%) of the 58 groin complications in PTA patients were treated by PR. There were no differences in transfusion requirements or length of stay. Conclusion?Vascular complications of TAVR are common with most being minor, related to access site and causing no immediate sequelae. Iliac injury can be managed by PR or OR. Aortic injury is associated with significant mortality. These findings increase vascular surgeons' awareness of these complications and how to manage them.

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Incidence and prognosis of vascular complications after transcatheter aortic valve implantation

Cited by 47 publications

References 28 publications

Efficacy and follow-up of transcatheter aortic valve implantation in patients with radiation-induced aortic stenosis

Efficacy and follow-up of transcatheter aortic valve implantation in patients with radiation-induced aortic stenosis

Multidetector CT Measurement of Myocardial Extracellular Volume in Acute Patchy and Contiguous Infarction: Validation with Microscopic Measurement

Vascular Complications Associated with Transfemoral Aortic Valve Replacement

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