Aortic Valve Transcatheter Intervention: Complications and Solutions

Aortic Valve Transcatheter Intervention Calcific aortic stenosis (AS) is the most common heart valve anomaly, with a largely age-dependent prevalence, a calculated annual incidence rate in the range of 4-5% in general populations and up to 6% in patients aged 75 years and over. Surgical aortic valve replacement (SAVR) was previously the only option available to patients with symptomatic, severe aortic stenosis. After the first-in-human transcatheter aortic valve implantation (TAVI) was performed by Alain Cribier in 2002, the treatment strategy for patients with symptomatic AS has been revolutionized. Since then, TAVI has grown exponentially, as a result of accruing evidence demonstrating safety and efficacy, and reduced invasiveness compared with SAVR. TAVI devices are continuously expanding to include several valve design options. As this strategy is continuously evolving to treat younger patients and lower-risk populations, aside from the long-term durability of the valve systems, procedural safety will become the focus of newer-generation devices. This book is a practical handbook devoted to the optimization of TAVI procedures, through a focused containment of complications. Through an integrated evaluation of the clinical status, imaging techniques and laboratory findings, the authors provide readers with clear messages on preventive and therapeutic recommendations.

Table of Contents:
List of Contributors vii Foreword xiii Alain Cribier 1 Introduction 1 Marco Zimarino and Corrado Tamburino Part I General Complications 7 2 Vascular Complications 9 Sebastiano Immè and Claudia I. Tamburino 3 Annular Rupture 17 Claudia Reddavid, Carmelo Sgroi, Corrado Tamburino, and Marco Barbanti 4 Coronary Obstruction 25 Henrique B. Ribeiro, Antonio Fernando D. Freire, and Josep Rodés-Cabau 5 Cerebrovascular Events 35 Luca Testa, Mattia Squillace, Antonio Popolo Rubbio, Matteo Casenghi, Michele Bellamoli, and Francesco Bedogni 6 Ventricular Perforation 45 Mei Chau, Alfonso Ielasi, and Azeem Latib 7 Valve Migration 55 Heath SL Adams, Tiffany Patterson, Simon Redwood, and Bernard Prendergast 8 Paravalvular Leaks 65 Joris Ooms, Zouhair Rahhab, and Nicolas M. Van Mieghem 9 Conduction Disturbances 79 Itsik Ben-Dor and Ron Waksman 10 Leaflet Thrombosis 91 Sam Dawkins, Tarun Chakravarty, and Raj Makkar 11 Bleeding 97 Francesco Radico, Raffaele Piccolo, Umberto Ianni, Sabina Gallina, and Marco Zimarino 12 Renal Dysfunction 109 Francesco Saia, Gabriele Ghetti, and Nevio Taglieri Part II Specific Complications 117 13 Bicuspid Valve 119 Anna Franzone, Eugenio Stabile, Plinio Cirillo, and Giovanni Esposito 14 Degenerated Aortic Bioprosthesis 129 Tania Rodríguez-Gabella, Carlos Cortés, Alberto San Román, and Ignacio J. Amat-Santos 15 Low-Flow Low-Gradient Aortic Stenosis 139 Francesco Cardaioli, Chiara Fraccaro, Tommaso Fabris, and Giuseppe Tarantini 16 Concomitant Mitral Regurgitation 147 Felice Gragnano, Carmen Spaccarotella, Andreina Carbone, Augusto Esposito, Paolo Calabrò, and Giampaolo Niccoli 17 Alternative Transcatheter Approaches 161 Marco De Carlo, Cristina Giannini, and Anna Sonia Petronio 18 Transapical and Direct Aortic Approach 171 Filippo Capestro, Paolo Berretta, Utz Kappert, and Marco Di Eusanio 19 Patients Needing Hemodynamic Support 179 Jacopo Andrea Oreglia, Federico De Marco, Francesco Soriano, and Stefano Nava 20 Coronary Angiography and Interventions After TAVI 189 Stefano Cannata, Matteo Perfetti, Tanya Salvatore, Caterina Gandolfo, and Nicola Maddestra 21 Complex Femoral Accesses 201 Damiano Regazzoli, Jorge Sanz-Sánchez, Giulio Stefanini, and Bernhard Reimers 22 Low-Risk Patients 211 Brian C. Case, Toby Rogers, and Ron Waksman 23 Gender Peculiarities 229 Ridhima Goel, Davide Cao, and Roxana Mehran 24 The Pathologist Perspective 237 Sho Torii, Yu Sato, Dipti Surve, Maria E. Romero, Aloke V. Finn, and Renu Virmani 25 Conclusion: What We Learnt from Clinical Trials and Real-World Experience 253 Paolo D’Arrigo, Piera Capranzano, and Davide Capodanno Index 259

About the Author :
About the Editors Marco Zimarino, Institute of Cardiology “G. d’Annunzio” University, Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy Ron Waksman, MedStar Heart & Vascular Institute, Medstar Washington Hospital Center, Washington, DC, USA Ignacio J. Amat-Santos, Department of Cardiology, Instituto de Ciencias del Corazón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Hospital Clínico Universitario de Valladolid, Spain Corrado Tamburino, Azienda Ospedaliero-Universitaria Policlinico “G. Rodolico- San Marco”, University of Catania, Catania, Italy