Cardiac Structural Complications Following TAVR.

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.