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Updated: Feb 6, 2026

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Cardiac Structural Complications Following TAVR.

Silvia Mas-Peiro1, Guillem Muntané-Carol2,3, Julien Ternacle4

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|February 5, 2026
PubMed
Summary

Cardiac structural complications (CSCs) affect about 2% of transcatheter aortic valve replacement patients, with high mortality and surgery conversion rates. These complications did not decrease over time, necessitating further research into prevention and management.

Keywords:
consensusincidencepericardial effusiontranscatheter aortic valve replacement

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Cardiac structural complications (CSCs) are defined by the Valve Academic Research Consortium 3 consensus as critical periprocedural events after transcatheter aortic valve replacement (TAVR).
  • Understanding CSCs is crucial for improving TAVR outcomes.

Purpose of the Study:

  • To evaluate the incidence, timing, management, and clinical impact of CSCs in contemporary TAVR procedures.
  • To assess trends in CSCs over a 10-year period.

Main Methods:

  • A multicenter study involving 10,541 patients undergoing TAVR across 18 European and Canadian centers (2014-2024).
  • CSCs were classified according to Valve Academic Research Consortium 3 criteria, including cardiac structure compromise, new pericardial effusion, and coronary obstruction.
  • Patient data were collected prospectively and followed up to 1 year and annually thereafter.

Main Results:

  • CSCs occurred in 2.1% of patients, with 1.2% experiencing multiple complications.
  • The most frequent CSCs were cardiac structure compromise (1.4%) and new pericardial effusion (1.4%).
  • Intraprocedural events (75.6%) often necessitated conversion to open-heart surgery (27.6%), associated with a 35.3% 30-day mortality rate, particularly for annular rupture (41.0%).

Conclusions:

  • CSCs remain a significant concern in TAVR, affecting approximately 2% of patients without a decrease in incidence over a decade.
  • These complications frequently require surgical conversion and are linked to high mortality rates.
  • Further research is essential for developing preventive strategies and optimizing surgical bailout management for CSCs.