title: Incidence and treatment of procedural cardiovascular complications associated with trans-arterial and trans-apical interventional aortic valve implantation in 412 consecutive patients.
abstract: OBJECTIVE
  Trans-catheter aortic valve implantation (TAVI) technology is rapidly evolving, with 412 procedures having been performed at our institution. Herein, we report a complete, prospective analysis of complications occurring during transvascular and trans-apical implantations with two different prostheses.
  
  
  METHODS
  Between June 2007 and June 2010, 412 patients (258 female, mean age 80.3±7.2 years, logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) 20.2%±13.0%) underwent TAVI through either a retrograde (n=252 transfemoral, n=28 transaxillary, and n=5 transaortic) or antegrade (n=127 trans-apical) approach at our institution. The trans-apical access was chosen only in cases where transvascular implantation was not possible. As many as 283 CoreValve and 129 Edwards Sapien prostheses were implanted.
  
  
  RESULTS
  Thirty-day survival was 90.9%. Vascular complications occurred in 42 patients (10.2%). In four patients, lethal aortic root (n=3) or abdominal (n=1) aortic rupture occurred. Pericardial effusion developed in 53 patients (12.8%), which resulted in cardiac tamponade in 12 patients (2.9%). Twenty-three patients (5.6%) with valve malplacement were treated interventionally. In five patients (1.2%), emergency institution of cardiopulmonary bypass was required during the procedure for temporary support; all patients survived. Seventeen patients underwent re-intervention on the catheter valve (4.1%).
  
  
  CONCLUSIONS
  With growing experience, complications with TAVI may be avoided by proper patient selection and skillful management. Other complications, when they occur, require a specific treatment algorithm to avoid delay in decision making. A considerable number of complications after TAVI require surgical treatment. Therefore, the ideal environment for TAVI procedures is a hybrid operating room, where a multidisciplinary team of surgeons, cardiologists, and anesthesiologists is best fitted to meet the current needs associated with TAVI technology. A reduction in complications was seen after 300 cases. This finding attests to the complexity of the procedure in addition to the experience required to reduce the incidence of complications.
authors.affiliation: German Heart Center Munich, Munich, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Lange
authors.forename: Sabine
authors.initials: S
authors.lastname: Bleiziffer
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
authors.forename: Domenico
authors.initials: D
authors.lastname: Mazzitelli
authors.forename: Andrea
authors.initials: A
authors.lastname: Hutter
authors.forename: Peter
authors.initials: P
authors.lastname: Tassani-Prell
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Laborde
authors.forename: Robert
authors.initials: R
authors.lastname: Bauernschmitt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery; D006328:Cardiac Catheterization / Q000379:methods; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000628:therapy; D002983:Clinical Competence; D004812:Epidemiologic Methods; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D017202:Myocardial Ischemia / Q000209:etiology; D018579:Patient Selection; D010490:Pericardial Effusion / Q000209:etiology; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods