title: Complications after Transfemoral Transcatheter Aortic Valve Replacement with a Balloon-Expandable Prosthesis: The Importance of Preventative Measures and Contingency Planning.
abstract: Transcatheter aortic valve replacement (TAVR) with balloon-expandable Edwards-SAPIEN valve was superior to standard therapy in inoperable patients and noninferior to surgical aortic valve replacement in high surgical-risk, but operable patients, with severe symptomatic aortic stenosis in the randomized controlled PARTNER trial. Since the first case of TAVR with a balloon-expandable valve in 2002, several groups have reported their experience with balloon-expandable valves with high-procedural success. In the United States, the balloon-expandable Edwards-SAPIEN valve is the only transcatheter heart valve approved by the FDA for commercial use. Moreover, this is only in high-risk inoperable patients. Despite increasing experience with the TAVR procedure, it can be associated with complications, which can be technically challenging, even for an experienced operator. Complications associated with TAVR include vascular complications, valve malpositioning, regurgitation, embolization, coronary compromise, conduction abnormalities, stroke/transient ischemic attack, acute kidney injury, cardiac tamponade, and hemodynamic collapse. A thorough understanding of the procedure is essential for pre-emptive planning for procedural complications and early identification and management of complications are necessary for procedural success. We hereby review our experience of transfemoral TAVR with balloon-expandable valves, offer practical tips to maximize the likelihood of procedural success, describe pre-emptive strategies to prevent peri-procedural complications and bailout measures to manage them, should they occur. © 2018 Wiley Periodicals, Inc.
authors: Cedars-Sinai Heart Institute, Los Angeles, California.
authors: Tarun
authors: T
authors: Chakravarty
authors: Cedars-Sinai Heart Institute, Los Angeles, California.
authors: Hasan
authors: H
authors: Jilaihawi
authors: Cedars-Sinai Heart Institute, Los Angeles, California.
authors: Niraj
authors: N
authors: Doctor
authors: Cedars-Sinai Heart Institute, Los Angeles, California.
authors: Gregory
authors: G
authors: Fontana
authors: Cedars-Sinai Heart Institute, Los Angeles, California.
authors: James S
authors: JS
authors: Forrester
authors: Cedars-Sinai Heart Institute, Los Angeles, California.
authors: Wen
authors: W
authors: Cheng
authors: Cedars-Sinai Heart Institute, Los Angeles, California.
authors: Raj
authors: R
authors: Makkar
mesh_terms: D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D063126:Balloon Valvuloplasty / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D000066491:Clinical Decision-Making; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006350:Heart Valve Prosthesis; D006801:Humans; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D011474:Prosthesis Design; D011677:Punctures; D012307:Risk Factors; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome
keywords: TAVI; TAVR; aortic valve replacement; transcatheter aortic valve replacement