Reported Causes of Device Embolization Following Transcatheter Aortic Valve Replacement: A Systematic Review and...

In the last 2 decades, transcatheter aortic valve replacement (TAVR) has become widely adopted for the treatment of aortic valve stenosis, and prosthetic valve embolization (PVE) is one of the rarely reported, but often catastrophic, complications of this procedure. The authors performed an updated systematic review of contemporary studies to determine the prevalence of post-TAVR PVE and its associated risk factors. A systematic search was conducted in multiple databases for all relevant published studies from 2014 to August 2024. Studies reporting on embolization were included. Data extracted encompassed participants' characteristics, study characteristics, and clinical outcomes. Pooled event rates were calculated using the random effects method. In the final analysis, 34 studies reported 501 cases of device embolization, of which 50% were male with a mean age of 80.7 ± 3.16 years while the other 50% were female. The rate of PVE was 1.4%. About 80% of the embolization occurred in the intraprocedural period, with 61% of the embolized valves requiring surgical treatment. The prevalence of embolization across included studies was 1.4%, with most embolization occurring during the procedure. The chance of mortality is significantly heightened at about 18% to 20% at 30 days and ~30% at 1 year in some series, compared with much lower baseline rates for uncomplicated TAVR. Prosthetic valve embolization complicates TAVR procedures, increasing procedural complexity, with over 50% of instances resulting in conversion to surgical intervention. Given that this complication is rare (~1%), the overall risk is low in the general TAVR population, but for the individual, it is serious and warrants aggressive management.