Autopsy after transcatheter aortic valve implantation

Area of Science:

• Cardiovascular Pathology
• Medical Device Technology
• Forensic Medicine

Background:

• Transcatheter aortic valve implantation (TAVI) is a rapidly advancing cardiovascular procedure.
• Understanding post-TAVI mortality requires specialized pathological knowledge.
• Autopsy plays a crucial role in determining the exact cause of death after TAVI.

Purpose of the Study:

• To analyze autopsy findings in patients with a history of TAVI.
• To correlate autopsy findings with the time interval between TAVI and death.
• To evaluate the added value of autopsy compared to clinical diagnosis.

Main Methods:

• Retrospective analysis of 72 autopsy reports from 8 European centers.
• Categorization of cases based on time intervals: ≤72 hours, >72 hours to ≤30 days, and >30 days post-TAVI.
• Detailed examination of autopsy findings, including cardiovascular and cerebrovascular complications.

Main Results:

• Early mortality (≤72h) was primarily due to cardiogenic or hemorrhagic shock.
• Intermediate mortality (>72h to ≤30d) was linked to cardiogenic shock, sepsis, and respiratory failure.
• Late mortality (>30d) was predominantly caused by sepsis, often from infective endocarditis.
• Autopsy revealed unexpected findings in 61.1% of cases, altering the clinically determined cause of death.
• Cerebrovascular complications were noted in 12 patients.

Conclusions:

• Autopsy findings in TAVI patients show distinct patterns related to the time of death.
• Autopsy significantly contributes to the accuracy of the cause of death determination after TAVI.
• Comprehensive autopsy, including cerebral examination, is vital in the evolving field of cardiac device technology.