The most relevant complications of transcatheter aortic valve implantation according to VARC criteria

S Neragi-Miandoab, A Salemi
Minerva Cardioangiologica 2014, 62 (2): 205-20
Transcatheter aortic valve implantation (TAVI) has been shown to be a viable alternative for high-risk patients who may not tolerate a surgical aortic valve replacement. The Edwards Sapien valve and the CoreValve are the most widely implanted valves worldwide. The indication may be expanded to intermediate and eventually low-risk patients in future; however, this will require a better understanding of potential complications and selecting the right valve for each individual patient. Although TAVI has expanded physicians' ability to intervene in many high-risk patients, there are still circumstances under which this procedure should not be considered, and some drawbacks have been identified, including important differences in periprocedural risks, aortic regurgitation, stroke, kidney injury, access associated complications, and significant conduction disturbances. One major concern is the higher rate of paravalvular leakage compared to SAVR. The Valve Academic Research Consortium established an independent collaboration between Academic Research organizations and specialty societies (cardiology and cardiac surgery) in the US and Europe. Consensus criteria were developed for the following endpoints: mortality, myocardial infarction, stroke, bleeding, acute kidney injury, vascular complications, and prosthetic valve performance. VARC definitions have already been incorporated into research and clinical practice. However, as clinical experience with this technology has matured and expanded, certain definitions have become unsuitable or ambiguous. The VARC 2 recommendations try to define the following clinical endpoints: mortality, stroke, myocardial infarction, bleeding complications, acute kidney injury, vascular complications, conduction disturbances, and arrhythmias, as well as a miscellaneous category including relevant complications not otherwise categorized. This manuscript reviews the most relevant complications of TAVI-transapical and transfemoral.

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