Complications of transcatheter aortic valve implantation with the corevalve—What have we learned so far?
✍ Scribed by Issam D. Moussa
- Publisher
- John Wiley and Sons
- Year
- 2010
- Tongue
- English
- Weight
- 44 KB
- Volume
- 76
- Category
- Article
- ISSN
- 1522-1946
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✦ Synopsis
Percutaneous transcatheter aortic valve implantation (TAVI) provides an alternative to surgical aortic valve replacement in patients with severe aortic valvar stenosis considered to be at high or prohibitive surgical risk. Although this procedure remains investigational in the United States, it has become a reality in other parts of the world. The understandable unbridled enthusiasm for this procedure should, however, be tempered by a better appreciation and understanding of the new set of potentially serious periprocedural complications. Patients who undergo this procedure have already depleted cardiovascular reserve, and the TAVI devices being used remain relatively large and inflexible. Periprocedural complications after TAVI share similarities as well as differences between the two most commonly implanted valves, the balloon-expandable Edwards valve (Edwards Lifesciences, Irvine, CA), and the self-expandable CoreValve Revalving 1 System (Medtronic, MN).
The current report by Ussia et al. in this issue of the journal [1] is a much needed effort to enhance our understanding of TAVI periprocedural complications and their prevention and management. These investigators report their experience with the implantation of the 18 Fr. CoreValve Revalving 1 System (Medtronic, MN) in 110 patients with symptomatic severe aortic stenosis who are at high surgical risk. So what have we learned from this report?
VASCULAR COMPLICATIONS HEART BLOCK
The authors report a 20% incidence of complete heart block (CHB) within 24 hr of TAVI, a 43% incidence of new LBBB, and a 10% incidence of new LBBB and first-degree AV block. The overall need for permanent pacemaker (PPM) was 21%, which is similar to what has been previously reported [3]. The