Won-Keun Kim1,2,3,4, Ulrich Schäfer5, Didier Tchetche6, Holger Nef4, Martin Arnold7, Pablo Avanzas8,9,10, Tanja Rudolph11, Smita Scholtz12, Marco Barbanti13, Jörg Kempfert14,15,16, Antonio Mangieri17, Alexander Lauten18, Christian Frerker19, Sung-Han Yoon20, Andreas Holzamer21, Fabien Praz22, Ole De Backer23, Stefan Toggweiler24, Johannes Blumenstein25, Paola Purita26, Giuseppe Tarantini26, Christian Thilo27, Alexander Wolf28, Oliver Husser25, Costanza Pellegrini29, Christof Burgdorf30, Rosa Ana Hernandez Antolin31, Victor A Jiménez Díaz32, Christoph Liebetrau1,2,4, Niklas Schofer5, Helge Möllmann25, Holger Eggebrecht33, Lars Sondergaard23, Thomas Walther3, Thomas Pilgrim23, Michael Hilker22, Raj Makkar21, Axel Unbehaun17, Jochen Börgermann34, Cesar Moris8,9,10, Stephan Achenbach7, Oliver Dörr4, Bruno Brochado6, Lenard Conradi35, Christian W Hamm1,2,4. 1. Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany. 2. DZHK (German Center for Cardiovascular Research), Partner Site Rhein-Main, Frankfurt am Main, Germany. 3. Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany. 4. Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany. 5. Department of General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf (UKE), Germany. 6. Groupe Cardiovasculaire Interventionel (GCVI), Clinique Pasteur, Toulouse, France. 7. Department of Cardiology, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany. 8. Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain. 9. Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain. 10. Department of Medicine, University of Oviedo, Oviedo, Spain. 11. Department of Cardiology, University of Cologne, Heart Center, Cologne, Germany. 12. Department of Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany. 13. Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy. 14. Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany. 15. DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany. 16. Department of Cardiothoracic Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. 17. EMO-GVM Centro Cuore and San Raffaele Hospitals, Milan, Italy. 18. Department of Cardiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany. 19. Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. 20. Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA, USA. 21. Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany. 22. Department of Cardiology, University Hospital Bern, Bern, Switzerland. 23. The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 24. Heart Center Lucerne, Lucerner Kantonsspital, Lucerne, Switzerland. 25. Department of Cardiology, St. Johannes Hospital, Dortmund, Germany. 26. Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy. 27. Klinikum Augsburg, Herzzentrum, Augsburg, Germany. 28. Department of Cardiology and Angiology, Elisabeth-Hospital Essen, Germany. 29. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany. 30. Department of Cardiology, Heart and Vascular Center Bad Bevensen, Bad Bevensen, Germany. 31. University Hospital Ramon Y Cajal-Madrid, Interventional Cardiology Unit, Madrid, Spain. 32. Hospital Alvaro Cunqueiro, Interventional Cardiology Unit, Department of Cardiology, University Hospital of Vigo, Vigo, Spain. 33. Department of Cardiology, Cardioangiologisches Centrum Bethanien (CCB) at the AGAPLESION Bethanien Hospital, Frankfurt, Germany. 34. Herz- und Diabeteszentrum NRW, Department of Cardiovascular Surgery, Ruhr-University Bochum, Bad Oeynhausen, Germany. 35. Department of Cardiovascular Surgery, University Heart Center, University Hospital Hamburg-Eppendorf (UKE), Germany.
Abstract
AIMS: Peri-procedural transcatheter valve embolization and migration (TVEM) is a rare but potentially devastating complication of transcatheter aortic valve implantation (TAVI). We sought to assess the incidence, causes, and outcome of TVEM in a large multicentre cohort. METHODS AND RESULTS: We recorded cases of peri-procedural TVEM in patients undergoing TAVI between January 2010 and December 2017 from 26 international sites. Peri-procedural TVEM occurred in 273/29 636 (0.92%) TAVI cases (age 80.8 ± 7.3 years; 53.8% female), of which 217 were to the ascending aorta and 56 to the left ventricle. The use of self-expanding or first-generation prostheses and presence of a bicuspid aortic valve were independent predictors of TVEM. Bail-out measures included repositioning attempts using snares or miscellaneous tools (41.0%), multiple valve implantations (83.2%), and conversion to surgery (19.0%). Using 1:4-propensity matching, we identified a cohort of 235 patients with TVEM (TVEMPS) and 932 patients without TVEM (non-TVEMPS). In the matched cohort, all-cause mortality was higher in TVEMPS than in non-TVEMPS at 30 days (18.6% vs. 4.9%; P < 0.001) and after 1 year (30.5% vs. 16.6%; P < 0.001). Major stroke was more frequent in TVEMPS at 30 days (10.6% vs. 2.8%; P < 0.001), but not at 1 year (4.6% vs. 1.9%; P = 0.17). The need for emergent cardiopulmonary support, major stroke at 30 days, and acute kidney injury Stages 2 and 3 increased the risk of 1-year mortality, whereas a better renal function at baseline was protective. CONCLUSION: Transcatheter valve embolization and migration occurred in approximately 1% and was associated with increased morbidity and mortality. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Peri-procedural transcatheter valve embolization and migration (TVEM) is a rare but potentially devastating complication of transcatheter aortic valve implantation (TAVI). We sought to assess the incidence, causes, and outcome of TVEM in a large multicentre cohort. METHODS AND RESULTS: We recorded cases of peri-procedural TVEM in patients undergoing TAVI between January 2010 and December 2017 from 26 international sites. Peri-procedural TVEM occurred in 273/29 636 (0.92%) TAVI cases (age 80.8 ± 7.3 years; 53.8% female), of which 217 were to the ascending aorta and 56 to the left ventricle. The use of self-expanding or first-generation prostheses and presence of a bicuspid aortic valve were independent predictors of TVEM. Bail-out measures included repositioning attempts using snares or miscellaneous tools (41.0%), multiple valve implantations (83.2%), and conversion to surgery (19.0%). Using 1:4-propensity matching, we identified a cohort of 235 patients with TVEM (TVEMPS) and 932 patients without TVEM (non-TVEMPS). In the matched cohort, all-cause mortality was higher in TVEMPS than in non-TVEMPS at 30 days (18.6% vs. 4.9%; P < 0.001) and after 1 year (30.5% vs. 16.6%; P < 0.001). Major stroke was more frequent in TVEMPS at 30 days (10.6% vs. 2.8%; P < 0.001), but not at 1 year (4.6% vs. 1.9%; P = 0.17). The need for emergent cardiopulmonary support, major stroke at 30 days, and acute kidney injury Stages 2 and 3 increased the risk of 1-year mortality, whereas a better renal function at baseline was protective. CONCLUSION: Transcatheter valve embolization and migration occurred in approximately 1% and was associated with increased morbidity and mortality. Published on behalf of the European Society of Cardiology. All rights reserved.
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