Challenges After the First Decade of Transcatheter Aortic Valve Replacement: Focus on Vascular Complications, Stroke, and Paravalvular Leak
| Autor: | Kamrouz Ghadimi, John G.T. Augoustides, Prakash A. Patel, Christopher Reidy, Harish Ramakrishna, Aris Sophocles |
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| Rok vydání: | 2013 |
| Předmět: |
Cardiac Catheterization
medicine.medical_specialty medicine.medical_treatment Pseudoaneurysm Postoperative Complications Valve replacement Aortic Valve Annulus Internal medicine medicine Humans Vascular Diseases Cardiac skeleton Stroke Heart Valve Prosthesis Implantation business.industry valvular heart disease Atrial fibrillation Embolic Protection Devices medicine.disease Surgery Treatment Outcome Anesthesiology and Pain Medicine Cardiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Cardiothoracic and Vascular Anesthesia. 27:184-189 |
| ISSN: | 1053-0770 |
| DOI: | 10.1053/j.jvca.2012.09.002 |
| Popis: | Transcatheter aortic valve replacement (TAVR) is entering its second decade. Three major clinical challenges have emerged from the first decade of experience: vascular complications, stroke, and paravalvular leak (PVL). Major vascular complications remain common and independently predict major bleeding, transfusion, renal failure, and mortality. Although women are more prone to vascular complications, overall they have better survival than men. Further predictors of major vascular complications include heavily diseased femoral arteries and operator experience. Strategies to minimize vascular complications include a multimodal approach and sleeker delivery systems. Although cerebral embolism is very common during TAVR, it mostly is asymptomatic. Major stroke independently predicts prolonged recovery and increased mortality. Identified stroke predictors include functional disability, previous stroke, a transapical approach, and atrial fibrillation. Embolic protection devices are in development to mitigate the risk of embolic stroke after TAVR. PVL is common and significantly decreases survival. Undersizing of the valve prosthesis can be minimized with 3-dimensional imaging by computed tomography or echocardiography to describe the elliptic aortic annulus accurately. The formal grading of PVL severity in TAVR is based on its percentage of the circumferential extent of the aortic valve annulus. Further emerging management strategies for PVL include a repositionable valve prosthesis and transcatheter plugging. The first decade of TAVR has ushered in a new paradigm for the multidisciplinary management of valvular heart disease. The second decade likely will build on this wave of initial success with further significant innovations. |
| Databáze: | OpenAIRE |
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