Catastrophic Cardiac Events During Transcatheter Aortic Valve Replacement

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Transcatheter aortic valve replacement (TAVR) is a growing procedure with decreasing but potentially catastrophic complications.
• Systematic data on severe cardiac events during contemporary TAVR are limited.

Purpose of the Study:

• To determine the incidence and outcomes of catastrophic cardiac events during TAVR.
• To analyze the perioperative management strategies for these events.
• To propose a framework for addressing TAVR-related catastrophic complications.

Main Methods:

• Retrospective cohort study of TAVR patients from 2015-2019 at a single academic center.
• Inclusion criteria: patients experiencing catastrophic cardiac events during or immediately after TAVR.
• Data analysis focused on event types, management, and mortality.

Main Results:

• 51 (2.5%) of 2102 TAVR patients experienced catastrophic cardiac events.
• Common causes included cardiac perforation/tamponade, acute left-ventricular failure, and coronary artery obstruction.
• In-hospital mortality was significantly higher (25.5%) for patients with events, though it decreased over time.
• Aortic root disruption had the highest mortality rate (42.8%).

Conclusions:

• Catastrophic cardiac events in TAVR, though infrequent, significantly elevate perioperative mortality.
• Prompt identification and a coordinated perioperative team strategy are essential for effective management.
• Developing standardized approaches can mitigate the impact of these severe complications.