Postprocedural management of patients after transcatheter aortic valve implantation procedure with self-expanding bioprosthesis.
BACKGROUND
Transcatheter aortic valve implantation (TAVI) carries higher risk of post-procedural adverse events than conventional percutaneous cardiovascular interventions. We report our experience about postoperative management protocol adopted in our Division.


METHODS
One hundred and ten patients underwent TAVI and 108 were transferred to the cardiac intensive care unit (CICU) after procedure. During the first 48 hours, vital parameters were monitored continuously. Close attention was given to rhythm and atrio-ventricular conduction disturbances, systemic blood pressure, fluid balance and vascular accesses.


RESULTS
The most common complications were renal impairment (21.3%), femoral artery pseudo-aneurysms (FAP) (11%), new complete atrioventricular block (20.3 %), cerebral vascular accident (4.5%) and cardiac perforation due to temporary pacemaker lead (1.8%). Ultrasound-guided compression repair was considered the first line treatment for FAP, but in 6 cases surgical treatment was immediately performed due to the rapid expansion of FAP. Complete atrio-ventricular block occurred in 22 patients (20.3 %) within the first 24 hours after TAVI and a permanent pacemaker was implanted in 21 patients (19.1%). Acute kidney injury occurred in 18 patients (35%) with pre-procedural chronic renal failure and in 5 patients (9%) without preoperative renal dysfunction.


CONCLUSIONS
After TAVI, cardiovascular complications are common and therefore accurate standardized management of patients in CICU during the first 48 hours is mandatory to early detect and manage complications and to decrease the rate of adverse events and the length of in-hospital stay. © 2010 Wiley-Liss, Inc.
Ussia
Gian Paolo
GP
Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy. gpussia@hotmail.com
Scarabelli
Marilena
M
Mulè
Massimiliano
M
Barbanti
Marco
M
Cammalleri
Valeria
V
Immè
Sebastiano
S
Aruta
Patrizia
P
Pistritto
Anna Maria
AM
Carbonaro
Alessandro
A
Deste
Wanda
W
Sciuto
Paolo
P
Licciardello
Giovanni
G
Calvi
Valeria
V
Tamburino
Corrado
C
D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000209:etiology / Q000628:therapy; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D054537:Atrioventricular Block / Q000209:etiology / Q000628:therapy; D001705:Bioprosthesis; D002037:Bundle-Branch Block / Q000209:etiology; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002304:Cardiac Pacing, Artificial; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000628:therapy; D005260:Female; D005263:Femoral Artery; D006335:Heart Injuries / Q000209:etiology / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D007558:Italy; D008297:Male; D020519:Pericardiocentesis; D011474:Prosthesis Design; D011859:Radiography; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome