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Titel:

Incidence and outcome of peri-procedural transcatheter heart valve embolization and migration: the TRAVEL registry (TranscatheteR HeArt Valve EmboLization and Migration).

Dokumenttyp:
Journal Article
Autor(en):
Kim, Won-Keun; Schäfer, Ulrich; Tchetche, Didier; Nef, Holger; Arnold, Martin; Avanzas, Pablo; Rudolph, Tanja; Scholtz, Smita; Barbanti, Marco; Kempfert, Jörg; Mangieri, Antonio; Lauten, Alexander; Frerker, Christian; Yoon, Sung-Han; Holzamer, Andreas; Praz, Fabien; De Backer, Ole; Toggweiler, Stefan; Blumenstein, Johannes; Purita, Paola; Tarantini, Giuseppe; Thilo, Christian; Wolf, Alexander; Husser, Oliver; Pellegrini, Costanza; Burgdorf, Christof; Antolin, Rosa Ana Hernandez; Díaz, Victor A J...     »
Abstract:
AIMS: Peri-procedural transcatheter valve embolization and migration (TVEM) is a rare but potentially devastating complication of transcatheter aortic valve implantation (TAVI). We sought to assess the incidence, causes, and outcome of TVEM in a large multicentre cohort. METHODS AND RESULTS: We recorded cases of peri-procedural TVEM in patients undergoing TAVI between January 2010 and December 2017 from 26 international sites. Peri-procedural TVEM occurred in 273/29 636 (0.92%) TAVI cases (age 80.8 ± 7.3 years; 53.8% female), of which 217 were to the ascending aorta and 56 to the left ventricle. The use of self-expanding or first-generation prostheses and presence of a bicuspid aortic valve were independent predictors of TVEM. Bail-out measures included repositioning attempts using snares or miscellaneous tools (41.0%), multiple valve implantations (83.2%), and conversion to surgery (19.0%). Using 1:4-propensity matching, we identified a cohort of 235 patients with TVEM (TVEMPS) and 932 patients without TVEM (non-TVEMPS). In the matched cohort, all-cause mortality was higher in TVEMPS than in non-TVEMPS at 30 days (18.6% vs. 4.9%; P < 0.001) and after 1 year (30.5% vs. 16.6%; P < 0.001). Major stroke was more frequent in TVEMPS at 30 days (10.6% vs. 2.8%; P < 0.001), but not at 1 year (4.6% vs. 1.9%; P = 0.17). The need for emergent cardiopulmonary support, major stroke at 30 days, and acute kidney injury Stages 2 and 3 increased the risk of 1-year mortality, whereas a better renal function at baseline was protective. CONCLUSION: Transcatheter valve embolization and migration occurred in approximately 1% and was associated with increased morbidity and mortality.
Zeitschriftentitel:
Eur Heart J
Jahr:
2019
Band / Volume:
40
Heft / Issue:
38
Seitenangaben Beitrag:
3156-3165
Volltext / DOI:
doi:10.1093/eurheartj/ehz429
PubMed:
http://view.ncbi.nlm.nih.gov/pubmed/31230081
Print-ISSN:
0195-668X
TUM Einrichtung:
Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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