Vascular Complications in TAVR: Incidence, Clinical Impact, and Management

Abstract

Transcatheter aortic valve replacement (TAVR) has replaced surgical aortic valve replacement as the new gold standard in elderly patients with severe aortic valve stenosis. However, alongside this novel approach, new complications emerged that require swift diagnosis and adequate management. Vascular access marks the first step in a TAVR procedure. There are several possible access sites available for TAVR, including the transfemoral approach as well as transaxillary/subclavian, transcarotid, transapical, and transcaval. Most cases are primarily performed through a transfemoral approach, while other access routes are mainly conducted in patients not suitable for transfemoral TAVR. As vascular access is achieved primarily by large bore sheaths, vascular complications are one of the major concerns during TAVR. With rising numbers of TAVR being performed, the focus on prevention and successful management of vascular complications will be of paramount importance to lower morbidity and mortality of the procedures. Herein, we aimed to review the most common vascular complications associated with TAVR and summarize their diagnosis, management, and prevention of vascular complications in TAVR.

Prognostic value of nutritional and inflammatory scores in Transcatheter aortic valve replacement patients

“…Conduction disorders, cerebral embolism, and complications related to percutaneous access sites continue to be common complications of TAVR that may bad influence the prognosis of patients [17][18][19] . These complications result in worse recovery of left ventricular function and a higher episode of readmission.…”

Evolving concepts in the management of antithrombotic therapy in patients undergoing transcatheter aortic valve implantation

“…Non-transfemoral access and sheath diameter have been reported as procedural risk factors [28]. Patient related risk factors include higher age, frailty and frequent comorbidities like renal insufficiency, anaemia and atrial fibrillation [28][29][30][31][32]. Furthermore, aortic stenosis related conditions like acquired type 2A von Willebrand factor (vWF) defect, angiodysplasia, (transient) trombocytopenia and Heyde's syndrome increase the hazards of bleeding [33,34].…”

The racial disparity among post transcatheter aortic valve replacement outcomes: A meta-analysis

“…AS is one of the most common valvular diseases, with a 2–7 % prevalence in the elderly patient population (>65 years) [4] , [5] . TAVR is the recommended procedure for AS, but it is not risk-free and many complications have been outlined in the literature related to this procedure [6] . The major complications reported are bleeding, stroke, acute kidney injury, atrioventricular block and paravalvular leakage [7] .…”