title: Transcatheter heart valve failure: a systematic review.
abstract: OBJECTIVE
  A comprehensive description of transcatheter heart valve (THV) failure has not been performed. We undertook a systematic review to investigate the aetiology, diagnosis, management, and outcomes of THV failure.
  
  
  RESULTS
  The systematic review was performed in accordance with the PRISMA guidelines using EMBASE, MEDLINE, and Scopus. Between December 2002 and March 2014, 70 publications reported 87 individual cases of transcatheter aortic valve implantation (TAVI) failure. Similar to surgical bioprosthetic heart valve failure, we observed cases of prosthetic valve endocarditis (PVE) (n = 34), structural valve failure (n = 13), and THV thrombosis (n = 15). The microbiological profile of THV PVE was similar to surgical PVE, though one-quarter had satellite mitral valve endocarditis, and surgical intervention was required in 40% (75% survival). Structural valve failure occurred most frequently due to leaflet calcification and was predominantly treated by redo-THV (60%). Transcatheter heart valve thrombosis occurred at a mean 9 ± 7 months post-implantation and was successfully treated by prolonged anticoagulation in three-quarters of cases. Two novel causes of THV failure were identified: late THV embolization (n = 18); and THV compression (n = 7) following cardiopulmonary resuscitation (CPR). These failure modes have not been reported in the surgical literature. Potential risk factors for late THV embolization include low prosthesis implantation, THV undersizing/underexpansion, bicuspid, and non-calcified anatomy. Transcatheter heart valve embolization mandated surgery in 80% of patients. Transcatheter heart valve compression was noted at post-mortem in most cases.
  
  
  CONCLUSIONS
  Transcatheter heart valves are susceptible to failure modes typical to those of surgical bioprostheses and unique to their specific design. Transcatheter heart valve compression and late embolization represent complications previously unreported in the surgical literature.
authors.affiliation: Department of Interventional Cardiology, McGill University Health Centre, Montreal, QC, Canada Department of Cardiology, Galway University Hospital, Galway, Ireland.
authors.forename: Darren
authors.initials: D
authors.lastname: Mylotte
authors.affiliation: Department of Interventional Cardiology, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Ali
authors.initials: A
authors.lastname: Andalib
authors.affiliation: Department of Interventional Cardiology, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Pascal
authors.initials: P
authors.lastname: Thériault-Lauzier
authors.affiliation: Department of Cardiac Surgery, German Heart Center, Munich, Germany.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Dorfmeister
authors.affiliation: Department of Interventional Cardiology, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Mina
authors.initials: M
authors.lastname: Girgis
authors.affiliation: Department of Interventional Cardiology, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Waleed
authors.initials: W
authors.lastname: Alharbi
authors.affiliation: Department of Interventional Cardiology, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Chetrit
authors.affiliation: Department of Interventional Cardiology, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Christos
authors.initials: C
authors.lastname: Galatas
authors.affiliation: Department of Interventional Cardiology, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Samuel
authors.initials: S
authors.lastname: Mamane
authors.affiliation: Department of Cardiology, Mortimer Davis, Jewish General Hospital, Montreal, QC, Canada.
authors.forename: Igal
authors.initials: I
authors.lastname: Sebag
authors.affiliation: Department of Interventional Cardiology, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Buithieu
authors.affiliation: Department of Interventional Cardiology, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Luc
authors.initials: L
authors.lastname: Bilodeau
authors.affiliation: Department of Cardiovascular Surgery, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Benoit
authors.initials: B
authors.lastname: de Varennes
authors.affiliation: Department of Cardiovascular Surgery, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Lachapelle
authors.affiliation: Department of Cardiac Surgery, German Heart Center, Munich, Germany.
authors.forename: Ruediger
authors.initials: R
authors.lastname: Lange
authors.affiliation: Department of Interventional Cardiology, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martucci
authors.affiliation: CVPath Institute, Gaithersburg, MD, USA.
authors.forename: Renu
authors.initials: R
authors.lastname: Virmani
authors.affiliation: Department of Interventional Cardiology, McGill University Health Centre, Montreal, QC, Canada Department of Cardiac Surgery, German Heart Center, Munich, Germany nicolopiazza@mac.com nicolopiazza@me.com.
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001024:Aortic Valve Stenosis / Q000601:surgery*; D004617:Embolism / Q000209:etiology; D004696:Endocarditis / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy; D006350:Heart Valve Prosthesis; D006660:Histoplasmosis / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure / Q000009:adverse effects*; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement
chemical_list: D000890:Anti-Infective Agents
keywords: Aortic stenosis; Heart valve failure; Prosthetic valve endocarditis; Transcatheter aortic valve implantation; Transcatheter heart valve failure