Impact of Subclinical Vascular Complications Detected by Systematic Postprocedural Multidetector Computed Tomography After Transcatheter Aortic Valve Implantation Using Balloon-Expandable Edwards SAPIEN XT Heart Valve.
Complications after transcatheter aortic valve implantation (TAVI) remain an important issue. This study aimed to evaluate the impact of systematic postprocedural multidetector computed tomography (MDCT) to detect subclinical complications after TAVI. From October 2013 to August 2015, a total of 135 patients who underwent transfemoral TAVI (n = 116) or transapical TAVI (n = 19) with Sapien XT and MDCT preprocedure and postprocedure were enrolled. Postprocedural MDCT findings were compared with the preprocedural MDCT findings. Cardiovascular complications were observed in 25.9% of patients, including 6 cases (4.5%) with major complications. Of those, clinically apparent major complications were reported in 2 cases including rupture of the sinus of Valsalva and iliac rupture. The complications in the remaining 4 cases (3.0%) included aortic dissection, aortic intramural hematoma, and left ventricular apical pseudoaneurysm, which were totally asymptomatic and only detected by MDCT. The apical pseudoaneurysm required surgical repair. Minor complications were observed in 21.5% of patients, 50% of which were subclinical. Only 1 case with femoral pseudoaneurysm required an additional procedure. Noncardiovascular findings were detected in 27.4% of patients; the most frequent were pleural effusions and atelectasis, which were predominantly observed in those treated through a transapical approach. Contrast-induced acute kidney injury after postprocedural MDCT was reported in 1 patient whose clinical course was complicated by sepsis. In conclusion, postprocedural MDCT was useful in detecting important subclinical complications that may affect the clinical course without deterioration of renal function.
Department of Cardiology, Keio University School of Medicine, Japan; Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.
Yuki
Y
Kakefuda
Department of Cardiology, Keio University School of Medicine, Japan. Electronic address: k-hayashida@umin.ac.jp.
Kentaro
K
Hayashida
Department of Diagnostic Radiology, Keio University School of Medicine, Japan.
Yoshitake
Y
Yamada
Department of Cardiology, Keio University School of Medicine, Japan.
Fumiaki
F
Yashima
Department of Cardiology, Keio University School of Medicine, Japan.
Taku
T
Inohara
Department of Cardiology, Keio University School of Medicine, Japan.
Ryo
R
Yanagisawa
Department of Cardiology, Keio University School of Medicine, Japan.
Makoto
M
Tanaka
Department of Cardiology, Keio University School of Medicine, Japan.
Takahide
T
Arai
Department of Cardiology, Keio University School of Medicine, Japan.
Takashi
T
Kawakami
Department of Cardiology, Keio University School of Medicine, Japan.
Yuichiro
Y
Maekawa
Department of Cardiology, Keio University School of Medicine, Japan.
Hikaru
H
Tsuruta
Department of Cardiology, Keio University School of Medicine, Japan.
Yuji
Y
Itabashi
Department of Cardiology, Keio University School of Medicine, Japan.
Mitsushige
M
Murata
Department of Cardiology, Keio University School of Medicine, Japan.
Motoaki
M
Sano
Department of Cardiovascular Surgery, Keio University School of Medicine, Japan.
Kazuma
K
Okamoto
Department of Cardiovascular Surgery, Keio University School of Medicine, Japan.
Akihiro
A
Yoshitake
Department of Cardiovascular Surgery, Keio University School of Medicine, Japan.
Hideyuki
H
Shimizu
Department of Diagnostic Radiology, Keio University School of Medicine, Japan.
Masahiro
M
Jinzaki
Department of Cardiology, Keio University School of Medicine, Japan.
Keiichi
K
Fukuda
D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D007479:Iopamidol; D008297:Male; D061330:Multidetector Computed Tomography; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011474:Prosthesis Design; D011857:Radiographic Image Interpretation, Computer-Assisted; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000295:instrumentation*
D003287:Contrast Media; D007479:Iopamidol