title: Outcome of patients after transcatheter aortic valve embolization.
abstract: OBJECTIVE
  This study aims to assess the mid- to long-term follow-up of patients after valve embolization at the time of transcatheter aortic valve implantation (TAVI).
  
  
  BACKGROUND
  Transcatheter heart valve (THV) embolization is a rare but serious complication during TAVI. Although various techniques have been developed to manage acute complications and reduce periprocedural morbidity/mortality, long-term clinical and hemodynamic consequences after these events are unknown.
  
  
  METHODS
  Patients who developed THV embolization after TAVI were prospectively assessed. Clinical and echocardiographic characteristics were recorded at baseline and after successful TAVI/surgical aortic valve replacement. The THV migration and strut fractures/degeneration were assessed by computed tomography.
  
  
  RESULTS
  A total of 7 patients had THV embolization, all of which occurred immediately after valve deployment. The embolized THV was repositioned in the aortic arch proximal to the left subclavian artery (n = 2), immediately distal to the left subclavian artery (n = 2), and in the abdominal aorta (n = 3). A second THV was implanted successfully at the same sitting in 4 patients and at the time of a second procedure in 2 patients. Elective conventional aortic valve replacement was performed in 1 patient. Median follow-up was 1,085 days. One patient died during follow-up from an unrelated cause. The remaining 6 survivors were in New York Heart Association functional class I or II at final follow-up. Mid-term computed tomography follow-up (n = 4,591 to 1,548 days) showed that the leaflets of the embolized THV remain open in all phases of the cardiac cycle. There was also no strut fracture or migration of these valves.
  
  
  CONCLUSIONS
  Clinical outcomes remain good when THV embolization is managed effectively. There are no apparent hemodynamic consequences of a second valve placed in the series. These embolized valves remain in a stable position with no evidence of strut fractures at mid-term follow-up.
authors.affiliation: St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Edgar L W
authors.initials: EL
authors.lastname: Tay
authors.forename: Ronen
authors.initials: R
authors.lastname: Gurvitch
authors.forename: Namal
authors.initials: N
authors.lastname: Wijeysinghe
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.forename: David A
authors.initials: DA
authors.lastname: Wood
authors.forename: Gerald
authors.initials: G
authors.lastname: Yong
authors.forename: Anson
authors.initials: A
authors.lastname: Cheung
authors.forename: Jian
authors.initials: J
authors.lastname: Ye
authors.forename: Samuel V
authors.initials: SV
authors.lastname: Lichtenstein
authors.forename: Ronald
authors.initials: R
authors.lastname: Carere
authors.forename: Christopher
authors.initials: C
authors.lastname: Thompson
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001955:British Columbia; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D004452:Echocardiography; D004562:Electrocardiography; D004617:Embolism / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011474:Prosthesis Design; D015641:Radiography, Interventional; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014904:Western Australia