Abstract 16850: Suicide Left Ventricle After Transcatheter Aortic Valve Replacement. A Systematic Review

Abstract

Introduction: Suicide left ventricle (LV) is an infrequent but severe complication of transcatheter aortic valve replacement (TAVR) that is poorly defined. It is generally referred to as hemodynamic collapse following valve deployment due to acute LV dynamic obstruction. Understanding this complication is essential for its prompt diagnosis and treatment. Methods: We conducted a systematic literature review for studies describing suicide LV (i.e., severe hypotension causing hemodynamic collapse and/or end-organ failure in the setting of a new or worsened dynamic intraventricular gradient after TAVR). Two authors reviewed each study for eligibility, and a third author resolved disagreements. Results: Of 506 studies, 27 publications were considered for the final analysis. Most patients that met the inclusion criteria of suicide LV were women (96%), demonstrating a small ventricle (70%), a hypertrophic septum (81%), and hyperdynamic contractility (50%) on pre-TAVR echocardiographic assessment. An intraventricular gradient pre-TAVR was found in half of the cases. Suicide LV manifested as severe hypotension occurred most often immediately after valve deployment. The LV outflow tract was the most common site of obstruction (85%) (i.e., LVOTO), compared to midventricular obstruction (MVO). Advanced therapies were required in nearly 70% of the cases. The most common advanced therapies were alcohol septal ablation and ventricular pacing. Conclusions: LV suicide after TAVR occurred almost invariably in women. The use of echocardiography before TAVR may be essential to anticipate this complication. Although previous studies report MVO being a more common site of dynamic intraventricular gradient after TAVR, LVOTO appears to carry the highest risk of suicide LV. Further research is required to predict better the risk of suicide LV to improve the ability to perform a bailout strategy in patients with hemodynamic collapse refractory to medical therapy.