title: Single center TAVR experience with a focus on the prevention and management of catastrophic complications.
abstract: BACKGROUND
  Transcatheter aortic valve replacement (TAVR) is an important treatment option for patients with severe symptomatic aortic stenosis (AS) who are inoperable or at high risk for complications with surgical aortic valve replacement. We report here our single-center data on consecutive patients undergoing transfemoral (TF) TAVR since the inception of our program, with a special focus on minimizing and managing complications.
  
  
  METHODS
  The patient population consists of all consecutive patients who underwent an attempted TF-TAVR at our institution, beginning with the first proctored case in May 2006, through December 2012. Clinical, procedural, and echocardiographic data were collected by chart review and echo database query. All events are reported according to Valve Academic Research Consortium-2.
  
  
  RESULTS
  During the study period, 255 patients with AS had attempted TF-TAVR. The procedure was successful in 244 (95.7%) patients. Serious complications including aortic annular rupture (n = 2), coronary occlusion (n = 2), iliac artery rupture (n = 1), and ventricular embolization (n = 1) were successfully managed. Death and stroke rate at 30 days was 0.4% and 1.6%, respectively. One-year follow-up was complete in 171 (76%) patients. One-year mortality was 17.5% with a 3.5% stroke rate. Descending aortic rupture, while advancing the valve, was the only fatal procedural event. There were 24.4% patients with ≥2+ aortic regurgitation.
  
  
  CONCLUSIONS
  TAVR can be accomplished with excellent safety in a tertiary center with a well-developed infrastructure for the management of serious complications. The data presented here provide support for TAVR as an important treatment option, and results from randomized trials of patients with lower surgical risk are eagerly awaited.
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
authors.forename: Eric
authors.initials: E
authors.lastname: Roselli
authors.forename: Paul
authors.initials: P
authors.lastname: Schoenhagen
authors.forename: Zoran
authors.initials: Z
authors.lastname: Popovic
authors.forename: Andrej
authors.initials: A
authors.lastname: Alfirevic
authors.forename: Benico
authors.initials: B
authors.lastname: Barzilai
authors.forename: Amar
authors.initials: A
authors.lastname: Krishnaswamy
authors.forename: William
authors.initials: W
authors.lastname: Stewart
authors.forename: Anand
authors.initials: A
authors.lastname: Mehta
authors.forename: Kanhaiya
authors.initials: K
authors.lastname: Lal Poddar
authors.forename: Akhil
authors.initials: A
authors.lastname: Parashar
authors.forename: Dhruv
authors.initials: D
authors.lastname: Modi
authors.forename: Alper
authors.initials: A
authors.lastname: Ozkan
authors.forename: Umesh
authors.initials: U
authors.lastname: Khot
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Lytle
authors.forename: E
authors.initials: E
authors.lastname: Murat Tuzcu
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D001019:Aortic Rupture / Q000401:mortality / Q000517:prevention & control; D001021:Aortic Valve / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D015331:Cohort Studies; D023921:Coronary Stenosis / Q000517:prevention & control; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology* / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D012422:Rupture, Spontaneous / Q000517:prevention & control; D012720:Severity of Illness Index; D020521:Stroke / Q000401:mortality / Q000517:prevention & control; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D016896:Treatment Outcome
keywords: TAVR; aortic stenosis; comparative effectiveness/patient centered outcomes research; complications; percutaneous intervention; vascular access