Transcatheter aortic valve implantation is becoming a popular option for patients with severe aortic stenosis who are poor surgical candidates. The procedure is less invasive than open aortic valve replacement; however, perioperative complications from this procedure can be serious and life-threatening. Vascular access is usually obtained via the common femoral artery; the prosthetic valve must travel from this entry point to the heart, and then the valve must be deployed in a manner that disables native valve function.
Complications resulting in vascular injury include dissection/perforation/occlusion along the ileofemoral axis (incidence 11.7%), suture delivery system failure, aortic annular dissection, and aortic annular rupture.
Complications from valve positioning and deployment include atrioventricular block requiring pacemaker implantation (incidence 15.7%), prosthesis dislocation/embolization, retrograde embolization, acute coronary obstruction, paravalvular regurgitation, pericardial tamponade, TIA/stroke, acute renal failure requiring renal replacement therapy, and prosthesis-related endocarditis.
Acute ST changes observed on EKG and or LV dysfunction observed on TEE immediately after deployment of the valve suggest acute coronary occlusion. This complication can be managed by percutaneous coronary intervention and stent placement. “Reported cases of coronary obstruction after TAVI occurred more frequently in women, in patients receiving a balloon-expandable valve, and the LCA was the most commonly involved artery. Percutaneous coronary intervention was a feasible and successful treatment in most cases.”
Joanne Shannon, Marco Mussardo, Azeem Latib, Kensuke Takagi, Alaide Chieffo, Matteo Montorfano, Antonio Colombo Recognition and management of complications during transcatheter aortic valve implantation. Expert Rev Cardiovasc Ther: 2011, 9(7);913-26
Henrique Barbosa Ribeiro, Luis Nombela-Franco, Marina Urena, Michael Mok, Sergio Pasian, Daniel Doyle, Robert DeLarochellière, Mélanie Côté, Louis Laflamme, Hugo DeLarochellière, Ricardo Allende, Eric Dumont, Josep Rodés-Cabau Coronary obstruction following transcatheter aortic valve implantation: a systematic review. JACC Cardiovasc Interv: 2013, 6(5);452-61