Aortic Valve Transcatheter Intervention: Complications and Solutions

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A Practical Guide to Prevention and Treatment of Complications during Transcatheter Aortic Valve Implantation 

Calcific aortic stenosis (AS) is the most common heart valve anomaly, with a largely age-dependent prevalence, a calculated annual incidence rate in the range of 4-5% in general populations and up to 6% in patients aged 75 years and over.

Surgical aortic valve replacement (SAVR) was previously the only option available to patients with symptomatic, severe aortic stenosis. After the first-in-human transcatheter aortic valve implantation (TAVI) was performed by Alain Cribier in 2002, the treatment strategy for patients with symptomatic AS has been revolutionized. Since then, TAVI has grown exponentially, as a result of accruing evidence demonstrating safety and efficacy, and reduced invasiveness compared with SAVR. TAVI devices are continuously expanding to include several valve design options. As this strategy is continuously evolving to treat younger patients and lower-risk populations, aside from the long-term durability of the valve systems, procedural safety will become the focus of newer-generation devices.

This book is a practical handbook devoted to the optimization of TAVI procedures, through a focused containment of complications. Through an integrated evaluation of the clinical status, imaging techniques and laboratory findings, the authors provide readers with clear messages on preventive and therapeutic recommendations.

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List of Contributors vii

Foreword xiii
Alain Cribier

1 Introduction 1
Marco Zimarino and Corrado Tamburino

Part I General Complications 7

2 Vascular Complications 9
Sebastiano Immè and Claudia I. Tamburino

3 Annular Rupture 17

Claudia Reddavid, Carmelo Sgroi, Corrado Tamburino, and Marco Barbanti

4 Coronary Obstruction 25
Henrique B. Ribeiro, Antonio Fernando D. Freire, and Josep Rodés-Cabau

5 Cerebrovascular Events 35
Luca Testa, Mattia Squillace, Antonio Popolo Rubbio, Matteo Casenghi, Michele Bellamoli, and Francesco Bedogni

6 Ventricular Perforation 45
Mei Chau, Alfonso Ielasi, and Azeem Latib

7 Valve Migration 55
Heath SL Adams, Tiffany Patterson, Simon Redwood, and Bernard Prendergast

8 Paravalvular Leaks 65
Joris Ooms, Zouhair Rahhab, and Nicolas M. Van Mieghem

9 Conduction Disturbances 79
Itsik Ben-Dor and Ron Waksman

10 Leaflet Thrombosis 91
Sam Dawkins, Tarun Chakravarty, and Raj Makkar

11 Bleeding 97
Francesco Radico, Raffaele Piccolo, Umberto Ianni, Sabina Gallina, and Marco Zimarino

12 Renal Dysfunction 109
Francesco Saia, Gabriele Ghetti, and Nevio Taglieri

Part II Specific Complications 117

13 Bicuspid Valve 119
Anna Franzone, Eugenio Stabile, Plinio Cirillo, and Giovanni Esposito

14 Degenerated Aortic Bioprosthesis 129
Tania Rodríguez-Gabella, Carlos Cortés, Alberto San Román, and Ignacio J. Amat-Santos

15 Low-Flow Low-Gradient Aortic Stenosis 139
Francesco Cardaioli, Chiara Fraccaro, Tommaso Fabris, and Giuseppe Tarantini

16 Concomitant Mitral Regurgitation 147
Felice Gragnano, Carmen Spaccarotella, Andreina Carbone, Augusto Esposito, Paolo Calabrò, and Giampaolo Niccoli

17 Alternative Transcatheter Approaches 161
Marco De Carlo, Cristina Giannini, and Anna Sonia Petronio

18 Transapical and Direct Aortic Approach 171
Filippo Capestro, Paolo Berretta, Utz Kappert, and Marco Di Eusanio

19 Patients Needing Hemodynamic Support 179
Jacopo Andrea Oreglia, Federico De Marco, Francesco Soriano, and Stefano Nava

20 Coronary Angiography and Interventions After TAVI 189
Stefano Cannata, Matteo Perfetti, Tanya Salvatore, Caterina Gandolfo, and Nicola Maddestra

21 Complex Femoral Accesses 201
Damiano Regazzoli, Jorge Sanz-Sánchez, Giulio Stefanini, and Bernhard Reimers

22 Low-Risk Patients 211
Brian C. Case, Toby Rogers, and Ron Waksman

23 Gender Peculiarities 229
Ridhima Goel, Davide Cao, and Roxana Mehran

24 The Pathologist Perspective 237
Sho Torii, Yu Sato, Dipti Surve, Maria E. Romero, Aloke V. Finn, and Renu Virmani

25 Conclusion: What We Learnt from Clinical Trials and Real-World Experience 253
Paolo D’Arrigo, Piera Capranzano, and Davide Capodanno

Index 259

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