Single center TAVR experience with a focus on the prevention and management of catastrophic complications

Background Transcatheter aortic valve replacement (TAVR) is an important treatment option for patients with severe symptomatic aortic stenosis (AS) who are inoperable or at high risk for complications with surgical aortic valve replacement. We report here our single‐center data on consecutive patien...

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Veröffentlicht in:Catheterization and cardiovascular interventions 2014-11, Vol.84 (5), p.834-842
Hauptverfasser: Kapadia, Samir R., Svensson, Lars G., Roselli, Eric, Schoenhagen, Paul, Popovic, Zoran, Alfirevic, Andrej, Barzilai, Benico, Krishnaswamy, Amar, Stewart, William, Mehta, Anand, lal Poddar, Kanhaiya, Parashar, Akhil, Modi, Dhruv, Ozkan, Alper, Khot, Umesh, Lytle, Bruce W., Murat Tuzcu, E.
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container_end_page 842
container_issue 5
container_start_page 834
container_title Catheterization and cardiovascular interventions
container_volume 84
creator Kapadia, Samir R.
Svensson, Lars G.
Roselli, Eric
Schoenhagen, Paul
Popovic, Zoran
Alfirevic, Andrej
Barzilai, Benico
Krishnaswamy, Amar
Stewart, William
Mehta, Anand
lal Poddar, Kanhaiya
Parashar, Akhil
Modi, Dhruv
Ozkan, Alper
Khot, Umesh
Lytle, Bruce W.
Murat Tuzcu, E.
description Background Transcatheter aortic valve replacement (TAVR) is an important treatment option for patients with severe symptomatic aortic stenosis (AS) who are inoperable or at high risk for complications with surgical aortic valve replacement. We report here our single‐center data on consecutive patients undergoing transfemoral (TF) TAVR since the inception of our program, with a special focus on minimizing and managing complications. Methods The patient population consists of all consecutive patients who underwent an attempted TF‐TAVR at our institution, beginning with the first proctored case in May 2006, through December 2012. Clinical, procedural, and echocardiographic data were collected by chart review and echo database query. All events are reported according to Valve Academic Research Consortium‐2. Results During the study period, 255 patients with AS had attempted TF‐TAVR. The procedure was successful in 244 (95.7%) patients. Serious complications including aortic annular rupture (n = 2), coronary occlusion (n = 2), iliac artery rupture (n = 1), and ventricular embolization (n = 1) were successfully managed. Death and stroke rate at 30 days was 0.4% and 1.6%, respectively. One‐year follow‐up was complete in 171 (76%) patients. One‐year mortality was 17.5% with a 3.5% stroke rate. Descending aortic rupture, while advancing the valve, was the only fatal procedural event. There were 24.4% patients with ≥2+ aortic regurgitation. Conclusions TAVR can be accomplished with excellent safety in a tertiary center with a well‐developed infrastructure for the management of serious complications. The data presented here provide support for TAVR as an important treatment option, and results from randomized trials of patients with lower surgical risk are eagerly awaited. © 2014 Wiley Periodicals, Inc.
doi_str_mv 10.1002/ccd.25356
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We report here our single‐center data on consecutive patients undergoing transfemoral (TF) TAVR since the inception of our program, with a special focus on minimizing and managing complications. Methods The patient population consists of all consecutive patients who underwent an attempted TF‐TAVR at our institution, beginning with the first proctored case in May 2006, through December 2012. Clinical, procedural, and echocardiographic data were collected by chart review and echo database query. All events are reported according to Valve Academic Research Consortium‐2. Results During the study period, 255 patients with AS had attempted TF‐TAVR. The procedure was successful in 244 (95.7%) patients. Serious complications including aortic annular rupture (n = 2), coronary occlusion (n = 2), iliac artery rupture (n = 1), and ventricular embolization (n = 1) were successfully managed. Death and stroke rate at 30 days was 0.4% and 1.6%, respectively. One‐year follow‐up was complete in 171 (76%) patients. One‐year mortality was 17.5% with a 3.5% stroke rate. Descending aortic rupture, while advancing the valve, was the only fatal procedural event. There were 24.4% patients with ≥2+ aortic regurgitation. Conclusions TAVR can be accomplished with excellent safety in a tertiary center with a well‐developed infrastructure for the management of serious complications. The data presented here provide support for TAVR as an important treatment option, and results from randomized trials of patients with lower surgical risk are eagerly awaited. © 2014 Wiley Periodicals, Inc.</description><identifier>ISSN: 1522-1946</identifier><identifier>EISSN: 1522-726X</identifier><identifier>DOI: 10.1002/ccd.25356</identifier><identifier>PMID: 24407775</identifier><identifier>CODEN: CARIF2</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Academic Medical Centers ; Aged ; Aged, 80 and over ; Aortic Rupture - mortality ; Aortic Rupture - prevention &amp; control ; aortic stenosis ; Aortic Valve - physiopathology ; Aortic Valve Stenosis - diagnostic imaging ; Aortic Valve Stenosis - mortality ; Aortic Valve Stenosis - surgery ; Cardiology ; Cohort Studies ; comparative effectiveness/patient centered outcomes research ; complications ; Coronary Stenosis - prevention &amp; control ; Echocardiography, Doppler ; Female ; Follow-Up Studies ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Male ; Medical research ; Mortality ; percutaneous intervention ; Postoperative Complications - mortality ; Postoperative Complications - physiopathology ; Postoperative Complications - prevention &amp; control ; Retrospective Studies ; Risk Assessment ; Rupture, Spontaneous - prevention &amp; control ; Severity of Illness Index ; Stroke - mortality ; Stroke - prevention &amp; control ; Survival Rate ; TAVR ; Transcatheter Aortic Valve Replacement - adverse effects ; Transcatheter Aortic Valve Replacement - methods ; Transcatheter Aortic Valve Replacement - mortality ; Treatment Outcome ; Valvular and Structural Heart Diseases ; vascular access</subject><ispartof>Catheterization and cardiovascular interventions, 2014-11, Vol.84 (5), p.834-842</ispartof><rights>2014 The Authors. Catheterization and Cardiovascular Interventions. Published by Wiley Periodicals, Inc.</rights><rights>2014 Wiley Periodicals, Inc.</rights><rights>2014 The Authors. Catheterization and Cardiovascular Interventions. Published by Wiley Periodicals, Inc. 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5516-f77fb479fe399a3ae2178bec677eae3a375360e46cb404b34637a03e5356b1a93</citedby><cites>FETCH-LOGICAL-c5516-f77fb479fe399a3ae2178bec677eae3a375360e46cb404b34637a03e5356b1a93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fccd.25356$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fccd.25356$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24407775$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kapadia, Samir R.</creatorcontrib><creatorcontrib>Svensson, Lars G.</creatorcontrib><creatorcontrib>Roselli, Eric</creatorcontrib><creatorcontrib>Schoenhagen, Paul</creatorcontrib><creatorcontrib>Popovic, Zoran</creatorcontrib><creatorcontrib>Alfirevic, Andrej</creatorcontrib><creatorcontrib>Barzilai, Benico</creatorcontrib><creatorcontrib>Krishnaswamy, Amar</creatorcontrib><creatorcontrib>Stewart, William</creatorcontrib><creatorcontrib>Mehta, Anand</creatorcontrib><creatorcontrib>lal Poddar, Kanhaiya</creatorcontrib><creatorcontrib>Parashar, Akhil</creatorcontrib><creatorcontrib>Modi, Dhruv</creatorcontrib><creatorcontrib>Ozkan, Alper</creatorcontrib><creatorcontrib>Khot, Umesh</creatorcontrib><creatorcontrib>Lytle, Bruce W.</creatorcontrib><creatorcontrib>Murat Tuzcu, E.</creatorcontrib><title>Single center TAVR experience with a focus on the prevention and management of catastrophic complications</title><title>Catheterization and cardiovascular interventions</title><addtitle>Cathet. Cardiovasc. Intervent</addtitle><description>Background Transcatheter aortic valve replacement (TAVR) is an important treatment option for patients with severe symptomatic aortic stenosis (AS) who are inoperable or at high risk for complications with surgical aortic valve replacement. We report here our single‐center data on consecutive patients undergoing transfemoral (TF) TAVR since the inception of our program, with a special focus on minimizing and managing complications. Methods The patient population consists of all consecutive patients who underwent an attempted TF‐TAVR at our institution, beginning with the first proctored case in May 2006, through December 2012. Clinical, procedural, and echocardiographic data were collected by chart review and echo database query. All events are reported according to Valve Academic Research Consortium‐2. Results During the study period, 255 patients with AS had attempted TF‐TAVR. The procedure was successful in 244 (95.7%) patients. Serious complications including aortic annular rupture (n = 2), coronary occlusion (n = 2), iliac artery rupture (n = 1), and ventricular embolization (n = 1) were successfully managed. Death and stroke rate at 30 days was 0.4% and 1.6%, respectively. One‐year follow‐up was complete in 171 (76%) patients. One‐year mortality was 17.5% with a 3.5% stroke rate. Descending aortic rupture, while advancing the valve, was the only fatal procedural event. There were 24.4% patients with ≥2+ aortic regurgitation. Conclusions TAVR can be accomplished with excellent safety in a tertiary center with a well‐developed infrastructure for the management of serious complications. The data presented here provide support for TAVR as an important treatment option, and results from randomized trials of patients with lower surgical risk are eagerly awaited. © 2014 Wiley Periodicals, Inc.</description><subject>Academic Medical Centers</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Rupture - mortality</subject><subject>Aortic Rupture - prevention &amp; control</subject><subject>aortic stenosis</subject><subject>Aortic Valve - physiopathology</subject><subject>Aortic Valve Stenosis - diagnostic imaging</subject><subject>Aortic Valve Stenosis - mortality</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Cardiology</subject><subject>Cohort Studies</subject><subject>comparative effectiveness/patient centered outcomes research</subject><subject>complications</subject><subject>Coronary Stenosis - prevention &amp; control</subject><subject>Echocardiography, Doppler</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medical research</subject><subject>Mortality</subject><subject>percutaneous intervention</subject><subject>Postoperative Complications - mortality</subject><subject>Postoperative Complications - physiopathology</subject><subject>Postoperative Complications - prevention &amp; control</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Rupture, Spontaneous - prevention &amp; control</subject><subject>Severity of Illness Index</subject><subject>Stroke - mortality</subject><subject>Stroke - prevention &amp; control</subject><subject>Survival Rate</subject><subject>TAVR</subject><subject>Transcatheter Aortic Valve Replacement - adverse effects</subject><subject>Transcatheter Aortic Valve Replacement - methods</subject><subject>Transcatheter Aortic Valve Replacement - mortality</subject><subject>Treatment Outcome</subject><subject>Valvular and Structural Heart Diseases</subject><subject>vascular access</subject><issn>1522-1946</issn><issn>1522-726X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kUtv1DAUhSMEoqVlwR9AltjAIq1fsccbpGpKC1VVpFIKO8vx3My4JHawkz7-PQ4zHQESK9vX3z06956ieEXwAcGYHlq7OKAVq8STYpdUlJaSiu9PN3eiuNgpXqR0gzFWgqrnxQ7lHEspq93CfXF-2QKy4AeI6Oro-hLBfQ_RgbeA7tywQgY1wY4JBY-GFaA-wm2mXX4av0Cd8WYJXa6g0CBrBpOGGPqVs8iGrm9dLmU27RfPGtMmeLk594qvJx-u5h_L88-nn-ZH56WtKiLKRsqm5lI1wJQyzAAlclaDFVKCAWaYrJjAwIWtOeY144JJgxlM49fEKLZXvF_r9mPdwWIaLJpW99F1Jj7oYJz--8e7lV6GW80pI5TOssDbjUAMP0dIg-5cstC2xkMYkyaCMMXUTFQZffMPehPG6PN4E0W5IkJOjt6tKRtDShGarRmC9RSgzgHq3wFm9vWf7rfkY2IZOFwDd66Fh_8r6fn8-FGyXHe4NMD9tsPEH1rIvE797eJUX1fy-IRhrs_YLyEVtNU</recordid><startdate>20141101</startdate><enddate>20141101</enddate><creator>Kapadia, Samir R.</creator><creator>Svensson, Lars G.</creator><creator>Roselli, Eric</creator><creator>Schoenhagen, Paul</creator><creator>Popovic, Zoran</creator><creator>Alfirevic, Andrej</creator><creator>Barzilai, Benico</creator><creator>Krishnaswamy, Amar</creator><creator>Stewart, William</creator><creator>Mehta, Anand</creator><creator>lal Poddar, Kanhaiya</creator><creator>Parashar, Akhil</creator><creator>Modi, Dhruv</creator><creator>Ozkan, Alper</creator><creator>Khot, Umesh</creator><creator>Lytle, Bruce W.</creator><creator>Murat Tuzcu, E.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><general>BlackWell Publishing Ltd</general><scope>BSCLL</scope><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20141101</creationdate><title>Single center TAVR experience with a focus on the prevention and management of catastrophic complications</title><author>Kapadia, Samir R. ; Svensson, Lars G. ; Roselli, Eric ; Schoenhagen, Paul ; Popovic, Zoran ; Alfirevic, Andrej ; Barzilai, Benico ; Krishnaswamy, Amar ; Stewart, William ; Mehta, Anand ; lal Poddar, Kanhaiya ; Parashar, Akhil ; Modi, Dhruv ; Ozkan, Alper ; Khot, Umesh ; Lytle, Bruce W. ; Murat Tuzcu, E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5516-f77fb479fe399a3ae2178bec677eae3a375360e46cb404b34637a03e5356b1a93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Academic Medical Centers</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Rupture - mortality</topic><topic>Aortic Rupture - prevention &amp; control</topic><topic>aortic stenosis</topic><topic>Aortic Valve - physiopathology</topic><topic>Aortic Valve Stenosis - diagnostic imaging</topic><topic>Aortic Valve Stenosis - mortality</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Cardiology</topic><topic>Cohort Studies</topic><topic>comparative effectiveness/patient centered outcomes research</topic><topic>complications</topic><topic>Coronary Stenosis - prevention &amp; control</topic><topic>Echocardiography, Doppler</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Medical research</topic><topic>Mortality</topic><topic>percutaneous intervention</topic><topic>Postoperative Complications - mortality</topic><topic>Postoperative Complications - physiopathology</topic><topic>Postoperative Complications - prevention &amp; control</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Rupture, Spontaneous - prevention &amp; control</topic><topic>Severity of Illness Index</topic><topic>Stroke - mortality</topic><topic>Stroke - prevention &amp; control</topic><topic>Survival Rate</topic><topic>TAVR</topic><topic>Transcatheter Aortic Valve Replacement - adverse effects</topic><topic>Transcatheter Aortic Valve Replacement - methods</topic><topic>Transcatheter Aortic Valve Replacement - mortality</topic><topic>Treatment Outcome</topic><topic>Valvular and Structural Heart Diseases</topic><topic>vascular access</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kapadia, Samir R.</creatorcontrib><creatorcontrib>Svensson, Lars G.</creatorcontrib><creatorcontrib>Roselli, Eric</creatorcontrib><creatorcontrib>Schoenhagen, Paul</creatorcontrib><creatorcontrib>Popovic, Zoran</creatorcontrib><creatorcontrib>Alfirevic, Andrej</creatorcontrib><creatorcontrib>Barzilai, Benico</creatorcontrib><creatorcontrib>Krishnaswamy, Amar</creatorcontrib><creatorcontrib>Stewart, William</creatorcontrib><creatorcontrib>Mehta, Anand</creatorcontrib><creatorcontrib>lal Poddar, Kanhaiya</creatorcontrib><creatorcontrib>Parashar, Akhil</creatorcontrib><creatorcontrib>Modi, Dhruv</creatorcontrib><creatorcontrib>Ozkan, Alper</creatorcontrib><creatorcontrib>Khot, Umesh</creatorcontrib><creatorcontrib>Lytle, Bruce W.</creatorcontrib><creatorcontrib>Murat Tuzcu, E.</creatorcontrib><collection>Istex</collection><collection>Wiley Open Access</collection><collection>Wiley-Blackwell Free Backfiles(OpenAccess)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health &amp; 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Cardiovasc. Intervent</addtitle><date>2014-11-01</date><risdate>2014</risdate><volume>84</volume><issue>5</issue><spage>834</spage><epage>842</epage><pages>834-842</pages><issn>1522-1946</issn><eissn>1522-726X</eissn><coden>CARIF2</coden><abstract>Background Transcatheter aortic valve replacement (TAVR) is an important treatment option for patients with severe symptomatic aortic stenosis (AS) who are inoperable or at high risk for complications with surgical aortic valve replacement. We report here our single‐center data on consecutive patients undergoing transfemoral (TF) TAVR since the inception of our program, with a special focus on minimizing and managing complications. Methods The patient population consists of all consecutive patients who underwent an attempted TF‐TAVR at our institution, beginning with the first proctored case in May 2006, through December 2012. Clinical, procedural, and echocardiographic data were collected by chart review and echo database query. All events are reported according to Valve Academic Research Consortium‐2. Results During the study period, 255 patients with AS had attempted TF‐TAVR. The procedure was successful in 244 (95.7%) patients. Serious complications including aortic annular rupture (n = 2), coronary occlusion (n = 2), iliac artery rupture (n = 1), and ventricular embolization (n = 1) were successfully managed. Death and stroke rate at 30 days was 0.4% and 1.6%, respectively. One‐year follow‐up was complete in 171 (76%) patients. One‐year mortality was 17.5% with a 3.5% stroke rate. Descending aortic rupture, while advancing the valve, was the only fatal procedural event. There were 24.4% patients with ≥2+ aortic regurgitation. Conclusions TAVR can be accomplished with excellent safety in a tertiary center with a well‐developed infrastructure for the management of serious complications. The data presented here provide support for TAVR as an important treatment option, and results from randomized trials of patients with lower surgical risk are eagerly awaited. © 2014 Wiley Periodicals, Inc.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>24407775</pmid><doi>10.1002/ccd.25356</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record>
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subjects Academic Medical Centers
Aged
Aged, 80 and over
Aortic Rupture - mortality
Aortic Rupture - prevention & control
aortic stenosis
Aortic Valve - physiopathology
Aortic Valve Stenosis - diagnostic imaging
Aortic Valve Stenosis - mortality
Aortic Valve Stenosis - surgery
Cardiology
Cohort Studies
comparative effectiveness/patient centered outcomes research
complications
Coronary Stenosis - prevention & control
Echocardiography, Doppler
Female
Follow-Up Studies
Hospital Mortality
Humans
Kaplan-Meier Estimate
Male
Medical research
Mortality
percutaneous intervention
Postoperative Complications - mortality
Postoperative Complications - physiopathology
Postoperative Complications - prevention & control
Retrospective Studies
Risk Assessment
Rupture, Spontaneous - prevention & control
Severity of Illness Index
Stroke - mortality
Stroke - prevention & control
Survival Rate
TAVR
Transcatheter Aortic Valve Replacement - adverse effects
Transcatheter Aortic Valve Replacement - methods
Transcatheter Aortic Valve Replacement - mortality
Treatment Outcome
Valvular and Structural Heart Diseases
vascular access
title Single center TAVR experience with a focus on the prevention and management of catastrophic complications
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