Mechanical complications of transcatheter aortic valve replacement: a review article

Aortic stenosis (AS) represents a prevalent valvular heart disease, particularly affecting the elderly population, with substantial implications for morbidity and mortality. This review examines the epidemiology, pathophysiology, management strategies, complications, and future implications of AS and its treatment modalities, focusing primarily on transcatheter aortic valve replacement (TAVR). The prevalence of AS is rising as the population ages, with notable differences observed across various demographic groups and regions. Additionally, AS can also occur in younger adults, typically due to a bicuspid aortic valve, the most common congenital heart defect, which further contributes to the condition's growing clinical significance. Surgical aortic valve replacement (SAVR) has historically been the standard treatment for severe AS, but TAVR methods have emerged as a less invasive alternative, particularly for high-risk surgical candidates. SAVR has historically been the standard treatment for severe AS, but TAVR has undergone rapid evolution and widespread acceptance, with over 200 000 procedures performed globally. Various delivery routes for TAVR exist, each with its advantages and limitations, including transfemoral, subclavian, direct aortic, transapical, and transcarotid approaches. Complications associated with TAVR include vascular complications, stroke, conduction disturbances, coronary artery obstruction, acute kidney injury, infections, and others. Strategies for complication prevention and management are actively researched and implemented. The review also discusses future implications of TAVR, highlighting advancements in device technology, procedural techniques, patient selection criteria, and the expanding patient population eligible for TAVR. Despite challenges and complications, TAVR has revolutionized the treatment landscape for AS and offers hope for patients previously deemed unsuitable for surgery.