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  • Review Article
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Mechanisms and management of TAVR-related complications

Nature Reviews Cardiology volume 10, pages 685–695 (2013)Cite this article

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Key Points

  • Major complications occur in one-third of patients during the month after transcatheter aortic valve replacement (TAVR)

  • Adequate patient screening and selection, using a 'heart team' approach and multimodality imaging, is important for the prevention of TAVR-related complications

  • Complications should be anticipated during a multidisciplinary evaluation before TAVR, to enable prompt recognition and management should such events occur during the procedure

  • The TAVR team should always be ready to perform immediate percutaneous or surgical rescue interventions in the event of serious TAVR-related complications

  • Growing operator experience and upcoming technological refinements will reduce the incidence of TAVR-related complications in the future

Abstract

Patients with severe aortic stenosis who are at high surgical risk or not considered to be suitable candidates for surgical aortic valve replacement are increasingly being treated with transcatheter aortic valve replacement (TAVR). Although this novel treatment modality has been proven to be effective in this patient population, serious complications oc cur in approximately one-third of patients during the month after the procedure. Such events include myocardial infarction, cerebrovascular events, vascular complications, bleeding, acute kidney injury, valve regurgitation, valve malpositioning, coronary obstruction, and conduction disturbances and arrhythmias, which can all lead to death. Prevention of these complications should be based on patient screening and selection by a dedicated 'heart team' and the use of multimodality imaging. Anticipation and early recognition of these complications, followed by prompt management using a wide range of percutaneous or surgical rescue interventions, is vital to patient outcome. Continuous patient assessment and reporting of complications according to standardized definitions, in addition to growing operator experience and upcoming technological refinements, will hopefully reduce the future rate of complications related to this procedure.

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Figure 1: Stroke during transcatheter aortic valve replacement.
Figure 2: Embolic protection devices used during transcatheter aortic valve replacement.
Figure 3: Device landing-zone rupture.
Figure 4: Vascular events after transfemoral transcatheter aortic valve replacement.
Figure 5: Paravalvular regurgitation after transcatheter aortic valve replacement.
Figure 6: Valve embolization after transcatheter aortic valve replacement.
Figure 7: Coronary obstruction after transcatheter aortic valve replacement.

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  • 06 November 2013

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  1. Department of Cardiology, Bichat Hospital, University Paris VII, 46 Rue Henri-Huchard, Paris, 75018, France

    Amir-Ali Fassa, Dominique Himbert & Alec Vahanian

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A.-A. Fassa, researched data for the article. All the authors contributed to the discussion of content, wrote the article, and reviewed/edited the manuscript before submission.

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Correspondence to Alec Vahanian.

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Competing interests

A. Vahanian has received consulting fees/honoraria from Abbott, Edwards Lifesciences, Medtronic, and Valtech. D. Himbert is Proctor for Edwards Lifesciences and Medtronic. A.-A. Fassa declares no competing interests.

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Fassa, AA., Himbert, D. & Vahanian, A. Mechanisms and management of TAVR-related complications. Nat Rev Cardiol 10, 685–695 (2013). https://doi.org/10.1038/nrcardio.2013.156

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