Vascular Complications in TAVR: Incidence, Clinical Impact, and Management.

Markus Mach,Aref Arjomand,Sercan Okutucu,Sefik Gorkem Fatihoglu,Tillmann Kerbel,Paul Werner,Paul Simon,Martin Andreas

doi:10.3390/jcm10215046

Abstract

Transcatheter aortic valve replacement (TAVR) has replaced surgical aortic valve replacement as the new gold standard in elderly patients with severe aortic valve stenosis. However, alongside this novel approach, new complications emerged that require swift diagnosis and adequate management. Vascular access marks the first step in a TAVR procedure. There are several possible access sites available for TAVR, including the transfemoral approach as well as transaxillary/subclavian, transcarotid, transapical, and transcaval. Most cases are primarily performed through a transfemoral approach, while other access routes are mainly conducted in patients not suitable for transfemoral TAVR. As vascular access is achieved primarily by large bore sheaths, vascular complications are one of the major concerns during TAVR. With rising numbers of TAVR being performed, the focus on prevention and successful management of vascular complications will be of paramount importance to lower morbidity and mortality of the procedures. Herein, we aimed to review the most common vascular complications associated with TAVR and summarize their diagnosis, management, and prevention of vascular complications in TAVR.

Highlights

Transcatheter aortic valve replacement (TAVR) has become the new standard of therapy for patients with severe aortic stenosis, and de facto replaced surgical aortic valve replacement (SAVR) when applicable [1,2]
Vascular access is mainly achieved by puncturing the common femoral artery (CFA) and large bore sheaths that are advanced through retrograde access, and vascular complications are of significant concern during TAVR
With TAVR being an integral part of modern valvular interventions, the procedure has undergone an incredible evolution since first performed two decades ago

Summary

Introduction

Transcatheter aortic valve replacement (TAVR) has become the new standard of therapy for patients with severe aortic stenosis, and de facto replaced surgical aortic valve replacement (SAVR) when applicable [1,2]. Even though the first TAVR was performed via an antegrade transseptal approach, the transfemoral (TF) access is nowadays the most commonly used access strategy. It is applied in over 90% of all TAVR patients in most centers nowadays [1–3]. As the indication for TAVR is steadily moving towards lower-risk patients, an even stronger focus on the early diagnosis, adequate management, and prevention of these complications will be required for comparable results with SAVR. We hereby provide a broad overview of the most common vascular complications associated with TAVR, their effective management, and their prevention

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