Acute Hemodynamic Compromise After Transcatheter Aortic Valve Replacement Due to Dynamic Left Ventricle Obstruction: A Systematic Review

Abstract

Acute hemodynamic compromise post-TAVR due to dynamic left ventricle obstruction (LVO), also known as “Suicide left ventricle” is an infrequent but severe complication of transcatheter aortic valve replacement (TAVR) that is poorly defined in the literature.Understanding this complication is essential for its prompt diagnosis and optimal treatment.We conducted a systematic literature review using PubMed, Embase, Web of Science and Medline databases for studies describing acute hemodynamic compromise post-TAVR due to dynamic LVO or suicide left ventricle. Each study was reviewed by two authors individually for eligibility, and a third author resolved disagreements.From a total of 506 studies, 25 publications were considered for the final analysis. The majority of patients suffering from this condition were women, demonstrating a hypertrophic septum, a small ventricle, and hyperdynamic contractility on pre-TAVR echocardiographic assessment. An intraventricular gradient pre-TAVR was found in half of the cases. Acute hemodynamic compromise post-TAVR due to dynamic LVO manifested mainly as significant hypotension and occurred most often immediately after valve deployment. The left ventricle outflow tract (LVOT) was the most common site of obstruction. Advanced therapies were required in nearly 65% of the cases.In conclusion, acute hemodynamic compromise post-TAVR due to dynamic LVO occurred almost invariably in women. Echocardiography prior to TAVR may offer essential information to anticipate this complication. LVOT obstruction appears to carry the highest risk of developing this phenomenon. Advanced therapies should be promptly considered as a bailout strategy in patients with hemodynamic collapse refractory to medical therapy.