From the Guidelines
Post-operative complications following Transcatheter Aortic Valve Replacement (TAVR) include both immediate and delayed issues that require vigilant monitoring, with vascular complications, cardiac conduction abnormalities, stroke, paravalvular leak, acute kidney injury, and coronary obstruction being among the most significant concerns. According to the most recent and highest quality study, 1, the Valve Academic Research Consortium 3 introduces a new category of complications deemed to capture and classify injury of any cardiac structure occurring during the procedure. These complications can be major or minor and include injury involving the aortic annulus, left ventricle outflow tract, ventricular septum, left or right ventricle, left or right atrium, mitral valve apparatus, tricuspid valve apparatus, and coronary sinus.
Some of the key complications and their management strategies include:
- Vascular complications at the access site, such as bleeding, hematoma formation, or vessel damage requiring repair
- Cardiac conduction abnormalities, which occur in 10-30% of patients and may necessitate permanent pacemaker implantation, especially with self-expanding valves
- Stroke, a serious complication affecting 2-5% of patients due to embolization during the procedure
- Paravalvular leak, which may develop when the prosthetic valve doesn't seal completely against the native annulus, causing regurgitation
- Acute kidney injury, resulting from contrast exposure or hypoperfusion during the procedure
- Coronary obstruction, which can occur if the valve displaces native leaflet tissue over coronary ostia
The management of these complications typically involves a multidisciplinary approach, including the use of dual antiplatelet therapy, regular echocardiographic follow-up, and careful monitoring for signs of complications. As noted in 1, the choice of intervention, including TAVR or surgical AVR, should be made by a heart valve team consisting of an integrated, multidisciplinary group of healthcare professionals with expertise in valvular heart disease, cardiac imaging, interventional cardiology, cardiac anesthesia, and cardiac surgery.
In terms of specific management strategies, patients may require:
- Dual antiplatelet therapy with aspirin (81mg daily indefinitely) and clopidogrel (75mg daily for 3-6 months)
- Regular echocardiographic follow-up at 30 days, 6 months, 1 year, and annually thereafter to monitor valve function and detect complications early
- Careful monitoring for signs of complications, such as bleeding, stroke, or cardiac conduction abnormalities
- Prompt intervention, including surgical or percutaneous repair, in the event of a complication.
Overall, the management of post-operative complications following TAVR requires a comprehensive and multidisciplinary approach, with careful attention to the potential risks and benefits of different management strategies.
From the Research
Post-Operative Complications of TAVR
The post-operative complications of Transcatheter Aortic Valve Replacement (TAVR) include:
- Hypotension 2
- Vascular injury 2
- Anemia 2
- Stroke 2, 3
- New-onset atrial fibrillation 2
- Conduction disturbances 2, 4
- Kidney injury 2
- Major bleeding 5
- Vascular complications 5
- Paravalvular leak 4
Management of Complications
The management of these complications requires careful consideration and planning, including:
- Intensive care after TAVR 2
- Periprocedural anesthetic considerations 6
- Optimal pharmacological management after the procedure 4
- Management of coexistent coronary artery disease 3
- Prevention of periprocedural stroke 3
Recent Updates and Considerations
Recent updates and considerations in TAVR include: