Why do patients develop skin tags after TAVR (Transcatheter Aortic Valve Replacement)?

Skin Tags After TAVR: Causes and Management

Skin tags are not a recognized or documented complication following Transcatheter Aortic Valve Replacement (TAVR) procedures in any of the major clinical guidelines or research literature. The development of skin tags is not mentioned in any of the comprehensive TAVR guidelines from the American College of Cardiology or other major cardiovascular societies 1, 2.

Known Post-TAVR Complications

TAVR procedures are associated with several well-documented complications, but skin tags are not among them. The most common complications include:

• Vascular complications - particularly at access sites (typically femoral artery)

  • Hematoma
  • Retroperitoneal bleeding
  • Femoral artery pseudoaneurysm
  • Vascular insufficiency 1

• Cardiac complications

  • Heart block requiring pacemaker implantation (more common with self-expanding CoreValve) 1, 2
  • Paravalvular regurgitation 1
  • Device migration or malposition 1

• Other complications

  • Stroke (ischemic or hemorrhagic) 2
  • Acute kidney injury 1
  • Infective endocarditis (rare but serious) 3

Monitoring After TAVR

Post-TAVR monitoring focuses on:

1. Hemodynamic and electrocardiographic monitoring
2. Access site evaluation for vascular complications
3. Echocardiographic assessment of valve function
4. Monitoring for conduction abnormalities 1

Possible Explanations for Perceived Skin Tags

If patients are reporting or experiencing what appear to be skin tags after TAVR, potential explanations might include:

• Unrelated skin conditions - Skin tags are common in older adults (the typical TAVR population) and may be coincidental rather than causally related to the procedure

• Misidentification of vascular complications - Small hematomas or pseudoaneurysms at access sites might be mistaken for skin growths

• Wound healing anomalies - Unusual scarring at access sites could potentially be misidentified as skin tags

Clinical Recommendations

1. Document and examine any skin lesions reported by patients after TAVR

2. Distinguish between true skin tags and vascular complications - Vascular complications require prompt evaluation and potentially intervention 1, 4

3. Follow standard post-TAVR monitoring protocols focusing on the established complications:

   • Continuous ECG monitoring for at least 3 days
   • Regular assessment of access sites
   • Echocardiographic evaluation of valve function
   • Monitoring for signs of stroke or other systemic complications 2

4. Maintain recommended antithrombotic therapy - typically dual antiplatelet therapy with aspirin and clopidogrel for 3-6 months post-TAVR, with aspirin continued lifelong 1, 2

Conclusion

The development of skin tags is not a recognized complication of TAVR procedures based on current clinical guidelines and research. Patients undergoing TAVR should be monitored for the well-established complications, particularly vascular complications at access sites, conduction abnormalities, and valve function. Any unusual skin findings should be evaluated to rule out vascular complications that might require intervention.