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Transcatheter aortic valve replacement complications may be minimized by experience
Various complications related to the procedure included stroke, death and embolization.
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Percutaneous transcatheter aortic valve implantation carries potential risks, but can lead to better outcomes when carried out by physicians with more experience.
Researchers from St. Paul’s Hospital in Vancouver, British Columbia, Canada, enrolled 163 patients with severe symptomatic aortic stenosis and a high or prohibitive operative risk into the study. The researchers performed balloon-expandable transcatheter aortic valve implantations between November 2005 and February 2008. The researchers reported that 110 of the procedures were performed using the transarterial approach and 53 using the transapical approach. The results were presented at the American Heart Association Scientific Sessions 2008 in New Orleans.
According to the study results, the overall 30-day mortality rate among the high-risk population was 11% (n=18), and the rate decreased by 50% in the second half of the cohort. Unplanned percutaneous (n=2) or surgical (n=11) interventions had to be performed in 14 patients because of peripheral vascular complications. The researchers also reported an intraprocedural death rate of 1.2% within the cohort, with one death caused by arterial perforation and one caused by apical hemorrhage. The stroke rate among the cohort was 4.3%.
“We believe that most strokes were related to emboli from atheromas in the aortic wall,” Jean-Bernard Masson, MD, a cardiologist at St. Paul’s Hospital in Vancouver, British Columbia, Canada, said in his presentation. “The availability of a lower profile, smooth and thick steerable delivery catheter may prevent some strokes in the future.”
The researchers reported additional complications during the procedures. Mitral valve injury in one patient and valve embolization in seven patients resulted from positioning errors. Coronary ostial obstruction by a bulky leaflet was reported in one patient, and permanent pacemakers were implanted in nine patients (5.5%).
“Complications are possible with transcatheter aortic valve implantation, but considering the risk profile of our patients, the rate of complications was reasonably low,” Masson concluded. “It is unlikely that in the future we will be able to prevent all complications, but the lessons we learned, sometime fatefully, will be helpful in managing patients in the future.”
For more information:
- Masson J-B, Altwegg LA, Ali AA, et al. Incidence and management of procedural complications associated with transcatheter aortic valve implantation. #3048. Presented at: American Heart Association Scientific Sessions; Nov. 8-12, 2008; New Orleans.