%0 Journal Article
%T A Review of Most Relevant Complications of Transcatheter Aortic Valve Implantation
%A Siyamek Neragi-Miandoab
%A Robert E. Michler
%J ISRN Cardiology
%D 2013
%R 10.1155/2013/956252
%X Transcatheter aortic valve implantation (TAVI) has emerged for treating aortic stenosis in patients who are poor candidates for surgical aortic valve replacement. Currently, the balloon-expandable Edwards Sapien valve¡ªwhich is usually implanted via a transfemoral or transapical approach¡ªand the self-expanding CoreValve ReValving system¡ªwhich is designed for retrograde application¡ªare the most widely implanted valves worldwide. Although a promising approach for high-risk patients, the indication may be expanded to intermediate- and eventually low-risk patients in the future; however, doing so will require a better understanding of potential complications, risk factors for these complications, and strategies to individualize each patient to a different access route and a specific valve. This paper reviews the most relevant complications that may occur in patients who undergo catheter-based aortic valve implantation. 1. Introduction Although surgical aortic valve replacement (SAVR) carries low morbidity and mortality rates, some patients are not surgical candidates and/or carry a high risk [1¨C3]. With the advent of transcatheter aortic valve implantation (TAVI), many high-risk patients have become eligible for AVR [4]. The early results of landmark studies demonstrated that TAVI improves hemodynamics and is an alternative to SAVR in high-risk patients [5¨C8]. Many patient characteristics (as seen in most cited series) are presented in Tables 1, 2, and 3 [5, 9¨C19]. Table 1: Preoperative patient characteristics. Table 2: Patients' preoperative risk factors. Table 3: Previous cardiac conditions. Coronary artery disease mandates revascularization at the time of AVR. The indication for TAVI has expanded to patients who have had previous cardiac surgery [20, 21]. PCI before TAVI can be performed as staged or simultaneously with no increased mortality [22, 23]. In a series of 125 patients who underwent TAVI with CoreValve (PCI + TAVI; versus TAVI only; ), the 30-day mortality was 6% for patients who had TAVI only versus 2% for patients treated with PCI + TAVI [22]. Risk-scoring systems have been utilized to create some algorithms to select very-high-risk patients who would be appropriate candidates for TAVI. The logistic EuroSCORE (LES) and the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) are the standard scoring systems. Some other risks include liver disease, frailty, porcelain aorta, and previous radiation; these have not yet been properly addressed in current scoring systems [24]. Considering the recent developments in this field, a new
%U http://www.hindawi.com/journals/isrn.cardiology/2013/956252/