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Eur Heart J. 2015 Jun 1;36(21):1306-27. doi: 10.1093/eurheartj/ehu388. Epub 2014 Sep 28.

Transcatheter heart valve failure: a systematic review.

Author information

1
Department of Interventional Cardiology, McGill University Health Centre, Montreal, QC, Canada Department of Cardiology, Galway University Hospital, Galway, Ireland.
2
Department of Interventional Cardiology, McGill University Health Centre, Montreal, QC, Canada.
3
Department of Cardiac Surgery, German Heart Center, Munich, Germany.
4
Department of Cardiology, Mortimer Davis, Jewish General Hospital, Montreal, QC, Canada.
5
Department of Cardiovascular Surgery, McGill University Health Centre, Montreal, QC, Canada.
6
CVPath Institute, Gaithersburg, MD, USA.
7
Department of Interventional Cardiology, McGill University Health Centre, Montreal, QC, Canada Department of Cardiac Surgery, German Heart Center, Munich, Germany nicolopiazza@mac.com nicolopiazza@me.com.

Abstract

AIMS:

A comprehensive description of transcatheter heart valve (THV) failure has not been performed. We undertook a systematic review to investigate the aetiology, diagnosis, management, and outcomes of THV failure.

METHODS AND RESULTS:

The systematic review was performed in accordance with the PRISMA guidelines using EMBASE, MEDLINE, and Scopus. Between December 2002 and March 2014, 70 publications reported 87 individual cases of transcatheter aortic valve implantation (TAVI) failure. Similar to surgical bioprosthetic heart valve failure, we observed cases of prosthetic valve endocarditis (PVE) (n = 34), structural valve failure (n = 13), and THV thrombosis (n = 15). The microbiological profile of THV PVE was similar to surgical PVE, though one-quarter had satellite mitral valve endocarditis, and surgical intervention was required in 40% (75% survival). Structural valve failure occurred most frequently due to leaflet calcification and was predominantly treated by redo-THV (60%). Transcatheter heart valve thrombosis occurred at a mean 9 ± 7 months post-implantation and was successfully treated by prolonged anticoagulation in three-quarters of cases. Two novel causes of THV failure were identified: late THV embolization (n = 18); and THV compression (n = 7) following cardiopulmonary resuscitation (CPR). These failure modes have not been reported in the surgical literature. Potential risk factors for late THV embolization include low prosthesis implantation, THV undersizing/underexpansion, bicuspid, and non-calcified anatomy. Transcatheter heart valve embolization mandated surgery in 80% of patients. Transcatheter heart valve compression was noted at post-mortem in most cases.

CONCLUSION:

Transcatheter heart valves are susceptible to failure modes typical to those of surgical bioprostheses and unique to their specific design. Transcatheter heart valve compression and late embolization represent complications previously unreported in the surgical literature.

KEYWORDS:

Aortic stenosis; Heart valve failure; Prosthetic valve endocarditis; Transcatheter aortic valve implantation; Transcatheter heart valve failure

PMID:
25265974
DOI:
10.1093/eurheartj/ehu388
[Indexed for MEDLINE]

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