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DOI: 10.1055/s-0032-1332412
Complications during transcatheter aortic valve intervention requiring the use of extracorporal circulation: A single center experience
Objective: Even though Transcatheter aortic valve implantation (TAVI) is a promising treatment option for high-risk patients considered inoperable for surgical aortic valve replacement, use of the heart-lung-machine (HLM) is still necessary in some cases in order to control severe complications. We intended to evaluate incidence and outcome for TAVI patients requiring extra-corporal circulatory support during intervention in our institution.
Methods: Between June 2007 and August 2012, 380 TAVIs have been performed at our heart center by our heart team consisting of interventional cardiologists as well as cardiac surgeons. Both the Medtronic CoreValve and the Edwards Sapien XT transcatheter valve were used, the latter not only via the transfemoral but also via the transapical or transaortic approach. During this period eleven patients (2.9%), mean age 84.6 years, required the use of the extra-corporal circulation during TAVI. Reasons requiring HLM included apical bleeding (n = 3), conversion to conventional aortic valve replacement (n = 5), with one case of valve dislocation into the aortic arch, one in the left ventricle and three due to aortic annulus rupture as well as mechanical circulatory support due to hemodynamic instability (n = 3).
Results: 30-day mortality was 18.2% (n = 2). Two patients (18.2%) died later on, seven patients (63.6%) recovered with significant reduction of transvalvular gradients and none or mild aortic regurgitation. They were discharged between one to three weeks post interventional.
Conclusion: Severe intra-procedural complications during TAVI require the need for urgent cardiac surgical intervention. Thus it is important to provided continuous cardiac surgical standby including standby of the HLM. Even though patients are considered inoperable most complications can be controlled if treated immediately as shown by our results.