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Valvular heart diseases
Complications of transcatheter aortic valve implantation (TAVI): how to avoid and treat them
  1. Helge Möllmann1,
  2. Won-Keun Kim1,2,
  3. Jörg Kempfert2,
  4. Thomas Walther2,
  5. Christian Hamm1,3
  1. 1Department of Cardiology, Kerckhoff Heart Centre, Bad Nauheim, Germany
  2. 2Department of Cardiac Surgery, Kerckhoff Heart Centre, Bad Nauheim, Germany
  3. 3University of Giessen, Medical Clinic I, Giessen, Germany
  1. Correspondence to Dr Helge Möllmann, Department of Cardiology, Kerckhoff Heart Centre, Benekestrasse 2-8, Bad Nauheim 61231, Germany; h.moellmann{at}kerckhoff-klinik.de

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Curriculum topic: Valvular heart diseases

Transcutaneous aortic valve implantation (TAVI) has evolved into standard therapy for elderly patients with aortic valve stenosis who require surgical valve replacement. The rapid development from an experimental procedure 10 years ago to a routine intervention has only been possible because complication rates have declined considerably. This effect can be in part attributed to improvements in the valve prostheses and their delivery systems and, of course, to the tapering out of the learning curve due to increasing experience. Nonetheless, the procedure still bears specific risks for complications that may critically influence the outcome. Despite awareness of these risks the in-hospital mortality is still 5–8% as recently shown by the large scale German Aortic valve RegistrY (GARY).1

The Valve Academic Research Consortium (VARC) has provided a standardised approach on how to characterise the specific complications. This standardised endpoint definition was updated in 2012 in the VARC-2 consensus document.2 The composite endpoints—device success, early safety at 30 days, clinical efficacy after 30 days, and time-related valve safety—are detailed in box 1.

Box 1

Composite endpoints according to Valve Academic Research Consortium-2 (VARC-2)2

Device success

  • Absence of procedural mortality AND

  • Correct positioning of a single prosthetic heart valve into proper anatomical location AND

  • Intended performance of the prosthetic heart valve (no prosthesis–patient mismatch and mean aortic valve gradient <20 mm Hg or peak velocity <3 m/s) AND

  • No moderate or severe prosthetic valve regurgitation

Early safety (at 30 days)

  • All cause mortality

  • All strokes (disabling and non-disabling)

  • Life threatening bleeding

  • Acute kidney injury (stage 2 or 3, including renal replacement therapy)

  • Coronary artery obstruction requiring intervention

  • Major vascular complication

  • Valve related dysfunction requiring repeat procedure (balloon valvuloplasty, transcatheter aortic valve implantation (TAVI), or surgical aortic valve replacement)

Clinical efficacy (after 30 days)

  • All cause mortality

  • All strokes (disabling and non-disabling)

  • Hospitalisations for valve-related symptoms or worsening congestive …

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