From the Guidelines
True. Though uncommon, some complications during Transcatheter Aortic Valve Replacement (TAVR) can indeed be catastrophic and require immediate attention, specialized experience, and access to advanced life support technologies. These serious complications include vascular injuries, valve embolization, coronary obstruction, cardiac tamponade, and stroke, as outlined in the Valve Academic Research Consortium 3 1. When these events occur, they demand rapid recognition and intervention by a multidisciplinary team with expertise in various rescue techniques. The high-risk nature of these complications necessitates that TAVR procedures be performed in facilities with cardiac surgery backup, advanced imaging capabilities, and the ability to initiate mechanical circulatory support if needed, as recommended by the 2017 ACC expert consensus decision pathway for TAVR 1. Some key complications and their management include:
- Valve embolization, which may require aortic recapture, deployment in the descending aorta, or surgical extraction 1
- Central valvular aortic regurgitation, which is usually self-limited but may require gentle probing of leaflets or delivery of a second TAVR device 1
- Coronary obstruction, which can be managed with PCI or CABG, and is a major cardiac structural complication according to the Valve Academic Research Consortium 3 1 The ability to manage these complications effectively is crucial for minimizing morbidity, mortality, and improving quality of life for patients undergoing TAVR. Therefore, it is essential to prioritize the most recent and highest quality evidence, such as the 2021 Valve Academic Research Consortium 3 1, when making decisions about TAVR procedures. By doing so, clinicians can ensure that patients receive the best possible care and outcomes.
From the Research
TAVR Complications
- The provided studies do not directly address the question of catastrophic complications during TAVR that require immediate attention 2, 3, 4, 5, 6.
- However, the studies do mention various complications associated with TAVR, such as:
- These complications may be considered serious and potentially catastrophic, but the studies do not provide information on the frequency or severity of such complications requiring immediate attention.
- The importance of a multidisciplinary approach involving an experienced heart team is emphasized in the preoperative evaluation process to assess TAVR candidacy and manage potential complications 2, 6.