Transcatheter aortic valve implantation: complications and management

Transcatheter aortic valve implantation (TAVI) is an emerging and promising modality to treat severe aortic stenosis in a select group of patients who are poor surgical candidates. Despite the lesser degree of invasiveness of TAVI compared to open aortic valve replacement (AVR), TAVI is associated with a significant potential for serious life-threatening complications, both intraoperatively and postoperatively. These include vascular injuries, stroke, structural injury to the aorta and the heart and its valves, aortic root or annulus injury, conduction tissue injury, paravalvular leak, valve malposition, coronary complications such as obstruction or ischemia, pericardial effusion and tamponade, and procedural cardiac depression requiring immediate cardiopulmonary bypass for resuscitation. The prevention, detection, and treatment of these complications demands a skill set requiring the services of a cardiovascular surgeon with endovascular skills, an interventional cardiologist, a cardiac perfusion team, and cardiac anesthesia. Therefore, the optimal care of TAVI patients requires a multidisciplinary approach involving these services. The range of serious complications associated with TAVI, and the management strategies utilized in their treatment, are discussed.