Intrathoracic complications associated with trans‐femoral transcatheter aortic valve replacement: Implications for emergency surgical preparedness

Background Intrathoracic complications (ITC) requiring emergency surgical intervention occur during transcatheter aortic valve replacement (TAVR). Objectives Characterize the incidence, outcomes and predictors of ITC in a large cohort of transfemoral (TF) TAVR cases over a 5 year period. Methods Ret...

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Bibliographic Details
Published in:	Catheterization and cardiovascular interventions Vol. 96; no. 3; pp. E369 - E376
Main Authors:	Hodson, Robert W., Jin, Ruyun, Ring, Michael E., Gafoor, Sameer, Verburg, Shawnna, Lehr, Eric J., Spinelli, Kateri J.
Format:	Journal Article
Language:	English
Published:	Hoboken, USA John Wiley & Sons, Inc 01-09-2020 Wiley Subscription Services, Inc
Subjects:	Aged Aged, 80 and over Aortic valve Aortic Valve Stenosis - diagnosis Aortic Valve Stenosis - mortality Aortic Valve Stenosis - surgery Catheterization, Peripheral - adverse effects Catheterization, Peripheral - mortality Coronary artery Effusion Emergencies emergency sternotomy Female Femoral Artery Humans Incidence Intraoperative Complications - diagnosis Intraoperative Complications - mortality Intraoperative Complications - surgery intrathoracic complication Male Mortality Occlusion Punctures Registries Retrospective Studies Risk Assessment Risk Factors Sternotomy - adverse effects Sternotomy - mortality Tamponade Thorax Time Factors Transcatheter aortic valve replacement Transcatheter Aortic Valve Replacement - adverse effects Transcatheter Aortic Valve Replacement - mortality Treatment Outcome United States United States emergency sternotomy Transcatheter aortic valve replacement intrathoracic complication
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Summary:	Background Intrathoracic complications (ITC) requiring emergency surgical intervention occur during transcatheter aortic valve replacement (TAVR). Objectives Characterize the incidence, outcomes and predictors of ITC in a large cohort of transfemoral (TF) TAVR cases over a 5 year period. Methods Retrospective registry and chart review of all nonclinical trial TF‐TAVR patients from seven centers within one hospital system from 2012–2016. ITC were defined as cardiac perforation, new or worsening pericardial effusion/tamponade, annular rupture, thoracic aortic injury, aortic valve dislodgement, and coronary artery occlusion. Procedural and 30‐day outcomes and 1‐year mortality were compared between ITC and no ITC patients. Multivariable logistic regression was used to identify predictors of ITC. Results Over the study period, 1,581 patients had TF‐TAVR and 68 ITC occurred in 46 patients (2.9%). The most common ITCs were pericardial effusion/tamponade (59%), cardiac perforation (33%), and valve dislodgement (33%). ITC rate did not decline over time (rate (95% confidence interval) for 2012 = 0% (0–8.8%), 2013 = 1.3% (0–7.2%), 2014 = 4.4% (2.2–8.0%), 2015 = 3.5% (2.0–5.6%), and 2016 = 2.4% (1.5–3.8%)). ITC patients had worse 1‐year survival (ITC: 60.7% (45.1–73.1%), no ITC: 88.7% (87.0–90.3%); p < .001). The majority of ITC patient deaths occurred within the first 30 days. Multivariable models to predict ITC were not successful. Conclusions ITC did not decline over time in our cohort. Predictors of ITC could not be identified. While these events are rare, they are associated with worse procedural outcomes and mortality. Heart teams should continue to be prepared for emergency intervention.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1522-1946 1522-726X
DOI:	10.1002/ccd.28620