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JACC Cardiovasc Interv. 2016 Dec 26;9(24):2527-2538. doi: 10.1016/j.jcin.2016.09.034. Epub 2016 Nov 23.

Acquired Aseptic Intracardiac Shunts Following Transcatheter Aortic Valve Replacement: A Systematic Review.

Author information

1
Institute of Heart Sciences, Hospital Clínico Universitario, Valladolid, Spain.
2
Institute of Heart Sciences, Hospital Clínico Universitario, Valladolid, Spain. Electronic address: ijamat@gmail.com.
3
Quebec Heart & Lung Institute, Quebec, Quebec, Canada.
4
Hospital General Universitario Gregorio Marañón, Madrid, Spain.

Abstract

OBJECTIVES:

The aim of this study was to describe the incidence, mechanisms, features, and management of aseptic intracardiac shunts (AICS).

BACKGROUND:

AICS following transcatheter aortic valve replacement (TAVR) are an uncommon and barely described complication.

METHODS:

A systematic review was performed of all published cases of AICS following TAVR, and the incidence, predictors, main features, management, and related outcomes were analyzed.

RESULTS:

A total of 31 post-TAVR AICS were gathered. After excluding transapical fistulas, the 28 remaining cases corresponded with an incidence of about 0.5%. Mean age and mean logistic European System for Cardiac Operative Risk Evaluation score were 80 ± 11 years and 19.2 ± 8.3%, respectively. Prior radiation therapy for cancer was present in 14.3%, and 42.8% had severe calcification of the aortic valve. TAVR was undertaken using balloon-expandable prostheses in the majority of cases (85.7%), via the transapical approach in one-third. Median time from TAVR to diagnosis was 21 days (interquartile range: 7 to 30 days), with intraprocedural suspicion in 12 cases (42.9%) and a mean Qp/Qs ratio of 1.8 ± 0.6. The most common location for AICS was the interventricular septum (60.7%). Heart failure was frequent (46.4%), but 14 patients (50%) remained asymptomatic. Medical treatment (71.4%) was associated with poor outcomes (30-day mortality rate 25%), especially in symptomatic patients (35% vs. 0%; p = 0.020) and in those with higher Qp/Qs ratios (1.9 ± 0.6 vs. 1.4 ± 0.1), while cardiac surgery (3.6%), and percutaneous closure (25%) led to good outcomes after a median follow-up period of 3 months (interquartile range: 1 to 9 months).

CONCLUSIONS:

Post-TAVR AICS are uncommon but have high 30-day mortality if left untreated, especially in symptomatic patients. Percutaneous closure was feasible and safe in symptomatic patients but remains controversial in asymptomatic subjects.

KEYWORDS:

TAVR; cardiac shunts; percutaneous closure devices

PMID:
27889349
DOI:
10.1016/j.jcin.2016.09.034
[Indexed for MEDLINE]
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