Catastrophic Cardiac Events During Transcatheter Aortic Valve Replacement

• Published in: Canadian journal of cardiology 2021-10, Vol.37 (10), p.1522-1529
• Main Authors: Liang, Yafen, Dhoble, Abhijeet, Pakanati, Adarsh, Zhao, Yelin, Kork, Felix, Ruan, Wei, Markham, Travis, Smalling, Richard, Balan, Prakash, Estrera, Anthony, Nguyen, Tom C., Gregoric, Igor, Kar, Biswajit, Eltzschig, Holger
• Format: Article
• Language: English
• Subjects: Aged; Aortic Valve - surgery; Aortic Valve Stenosis - surgery; Female; Follow-Up Studies; Heart Failure - epidemiology; Heart Failure - etiology; Hospital Mortality - trends; Humans; Incidence; Male; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Retrospective Studies; Risk Assessment - methods; Risk Factors; Survival Rate - trends; Texas - epidemiology; Transcatheter Aortic Valve Replacement - adverse effects
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2021.05.002

Perioperative complications of transcatheter aortic valve replacement (TAVR) are decreasing but can be catastrophic when they occur. Systematic reports of the nature of these events are lacking in the contemporary era. Our study aimed to report the incidence, outcomes, and perioperative management of catastrophic cardiac events in patients undergoing TAVR and to propose a working strategy to address these complications. This is a retrospective cohort study of patients who developed catastrophic cardiac events during or immediately after TAVR between 2015 and 2019 at a single academic centre. Of 2102 patients who underwent TAVR, 51 (2.5%) developed catastrophic cardiac events. The causes included cardiac perforation and tamponade (n = 19, 37.3%), acute left- ventricular failure (n = 10, 19.6%), coronary artery obstruction (n = 10, 19.6%), aortic-root disruption (n = 7, 13.7%), and device embolization (n = 5, 9.8%). Twenty-four patients (47.0%) with catastrophic cardiac events required stabilization by either intra-aortic balloon counter-pulsation or extracorporeal membrane oxygenation. The in-hospital mortality rate increased by 11.7-fold for patients with catastrophic cardiac events compared with those without (25.5% vs 2.0%, P < 0.001). Patients who developed aortic root disruption had the highest mortality rate (42.8%) compared with the others. The incidence of catastrophic cardiac events remained stable over a 5-year period, but the associated mortality decreased from 38.5% in 2015 to 9.1% in 2019. Catastrophic cardiac events during TAVR are rare, but they account for a dramatic increase in perioperative mortality. Early recognition and development of a standardized perioperative team approach can help manage patients experiencing these complications. Les complications périopératoires d'un remplacement valvulaire aortique par cathéter (RVAC) diminuent, mais peuvent être catastrophiques lorsqu'elles surviennent. À l’époque actuelle, il n'y a pas de rapports systématiques sur la nature de ces événements. Notre étude visait à faire connaître la fréquence, l'issue et la prise en charge périopératoire des événements cardiaques catastrophiques chez des patients qui subissent un RVAC et à proposer une stratégie de travail pour remédier à ces complications. Il s'agit d'une étude de cohorte rétrospective portant sur des patients ayant présenté des événements cardiaques catastrophiques pendant ou immédiatement après un RVAC, entre 2015 et 2019, à un seul centre h