title: Pathology of transcatheter valve therapy.
abstract: OBJECTIVE
  This study sought to report on the pathology of transcatheter aortic valves explanted at early and late time points after transcatheter aortic valve implantation.
  
  
  BACKGROUND
  Information on pathological findings following transcatheter aortic valve implantation is scarce, particularly late after transcatheter aortic valve implantation.
  
  
  METHODS
  This study included 20 patients (13 men, median age 80 years [interquartile range: 72 to 84] years) with previous transcatheter aortic valve implantation with a valve explanted at autopsy (n = 17) or surgery (n = 3) up to 30 months after implantation (10 transapical and 10 transfemoral procedures).
  
  
  RESULTS
  Structural valve degeneration was not seen, although fibrous tissue ingrowth was observed at later time points with minimal effects on cusp mobility in 1 case. Minor alterations in valve configuration or placement were observed in up to 50% of cases, but they were not accompanied by substantial changes in valve function or reliably associated with chest compressions. Vascular or myocardial injury was common, especially within 30 days of transcatheter aortic valve implantation (about 69%), with the latter associated with left coronary ostial occlusion by calcified native aortic valve tissue in 2 cases. Mild to severe myocardial amyloidosis was present in nearly 33% of cases and likely played a role in the poor outcome of 3 patients. Endocarditis, migration of the valve, and embolization during the procedure led to surgical valve removal.
  
  
  CONCLUSIONS
  Structural degeneration was not seen and minor alterations of valve configuration or placement did not affect valve function and were not reliably caused by chest compressions. Vascular or myocardial injury is very common early after transcatheter aortic valve implantation and myocardial amyloidosis represents a relatively frequent potentially significant comorbid condition.
authors.affiliation: Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada; Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.affiliation: Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.affiliation: Division of Cardiac Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Jian
authors.initials: J
authors.lastname: Ye
authors.affiliation: Division of Cardiac Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Anson
authors.initials: A
authors.lastname: Cheung
authors.affiliation: Division of Cardiac Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Samuel V
authors.initials: SV
authors.lastname: Lichtenstein
authors.affiliation: Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Carere
authors.affiliation: Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Ronen
authors.initials: R
authors.lastname: Gurvitch
authors.affiliation: Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Thompson
authors.affiliation: Department of Pathology and Laboratory Medicine, University of British Columbia/St Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Avi J
authors.initials: AJ
authors.lastname: Ostry
authors.affiliation: Department of Pathology and Laboratory Medicine, University of British Columbia/St Paul's Hospital, Vancouver, British Columbia, Canada; University of British Columbia James Hogg Research Centre, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Lise
authors.initials: L
authors.lastname: Matzke
authors.affiliation: Department of Pathology and Laboratory Medicine, University of British Columbia/St Paul's Hospital, Vancouver, British Columbia, Canada; University of British Columbia James Hogg Research Centre, St. Paul's Hospital, Vancouver, British Columbia, Canada. Electronic address: mike.allard@pathology.ubc.ca.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Allard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000209:etiology / Q000473:pathology; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D001344:Autopsy; D001955:British Columbia; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000401:mortality; D009202:Cardiomyopathies / Q000209:etiology / Q000473:pathology; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002423:Cause of Death; D020878:Device Removal; D004696:Endocarditis / Q000209:etiology / Q000473:pathology; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology / Q000473:pathology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome