Author + information
- Received September 2, 2010
- Revision received October 8, 2010
- Accepted October 15, 2010
- Published online February 1, 2011.
- Edgar L.W. Tay, MD⁎,
- Ronen Gurvitch, MD⁎,
- Namal Wijeysinghe, MD⁎,
- Fabian Nietlispach, MD⁎,
- Jonathon Leipsic⁎,
- David A. Wood, MD⁎,
- Gerald Yong, MD†,
- Anson Cheung, MD⁎,
- Jian Ye, MD⁎,
- Samuel V. Lichtenstein, MD⁎,
- Ronald Carere, MD⁎,
- Christopher Thompson, MD⁎ and
- John G. Webb, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. John G. Webb, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
Objectives This study aims to assess the mid- to long-term follow-up of patients after valve embolization at the time of transcatheter aortic valve implantation (TAVI).
Background Transcatheter heart valve (THV) embolization is a rare but serious complication during TAVI. Although various techniques have been developed to manage acute complications and reduce periprocedural morbidity/mortality, long-term clinical and hemodynamic consequences after these events are unknown.
Methods Patients who developed THV embolization after TAVI were prospectively assessed. Clinical and echocardiographic characteristics were recorded at baseline and after successful TAVI/surgical aortic valve replacement. The THV migration and strut fractures/degeneration were assessed by computed tomography.
Results A total of 7 patients had THV embolization, all of which occurred immediately after valve deployment. The embolized THV was repositioned in the aortic arch proximal to the left subclavian artery (n = 2), immediately distal to the left subclavian artery (n = 2), and in the abdominal aorta (n = 3). A second THV was implanted successfully at the same sitting in 4 patients and at the time of a second procedure in 2 patients. Elective conventional aortic valve replacement was performed in 1 patient. Median follow-up was 1,085 days. One patient died during follow-up from an unrelated cause. The remaining 6 survivors were in New York Heart Association functional class I or II at final follow-up. Mid-term computed tomography follow-up (n = 4,591 to 1,548 days) showed that the leaflets of the embolized THV remain open in all phases of the cardiac cycle. There was also no strut fracture or migration of these valves.
Conclusions Clinical outcomes remain good when THV embolization is managed effectively. There are no apparent hemodynamic consequences of a second valve placed in the series. These embolized valves remain in a stable position with no evidence of strut fractures at mid-term follow-up.
Drs. Leipsic is on the Speakers' Bureau for Edwards Lifesciences. Drs. Webb, Ye, and Cheung are consultants for Edwards Lifesciences. All other authors have reported that they have no relationships to disclose.
- Received September 2, 2010.
- Revision received October 8, 2010.
- Accepted October 15, 2010.
- American College of Cardiology Foundation