Transcatheter heart valve failure: A systematic review

Darren Mylotte, Ali Andalib, Pascal Thériault-Lauzier, Magdalena Dorfmeister, Mina Girgis, Waleed Alharbi, Michael Chetrit, Christos Galatas, Samuel Mamane, Igal Sebag, Jean Buithieu, Luc Bilodeau, Benoit De Varennes, Kevin Lachapelle, Ruediger Lange, Giuseppe Martucci, Renu Virmani, Nicolo Piazza

Research output: Contribution to journalArticlepeer-review

188 Scopus citations

Abstract

Aims A comprehensive description of transcatheter heart valve (THV) failure has not been performed. We undertook a systematic review to investigate the aetiology, diagnosis, management, and outcomes of THV failure. Methods and results The systematic review was performed in accordance with the PRISMA guidelines using EMBASE, MEDLINE, and Scopus. Between December 2002 and March 2014, 70 publications reported 87 individual cases of transcatheter aortic valve implantation (TAVI) failure. Similar to surgical bioprosthetic heart valve failure, we observed cases of prosthetic valve endocarditis (PVE) (n = 34), structural valve failure (n = 13), and THV thrombosis (n = 15). The microbiological profile of THV PVE was similar to surgical PVE, though one-quarter had satellite mitral valve endocarditis, and surgical intervention was required in 40% (75% survival). Structural valve failure occurred most frequently due to leaflet calcification and was predominantly treated by redo-THV (60%). Transcatheter heart valve thrombosis occurred at a mean 9+7 months post-implantation and was successfully treated by prolonged anticoagulation in three-quarters of cases. Twonovel causes of THV failurewere identified: lateTHVembolization (n = 18); and THV compression (n = 7) following cardiopulmonary resuscitation (CPR). These failure modes have not been reported in the surgical literature. Potential risk factors for late THV embolization include low prosthesis implantation, THV undersizing/underexpansion, bicuspid, and non-calcified anatomy. Transcatheter heart valve embolization mandated surgery in 80% of patients. Transcatheter heart valve compression was noted at post-mortem in most cases. Conclusion Transcatheter heart valves are susceptible to failure modes typical to those of surgical bioprostheses and unique to their specific design. Transcatheter heart valve compression and late embolization represent complications previously unreported in the surgical literature.

Original languageEnglish
Pages (from-to)1306-1327
Number of pages22
JournalEuropean Heart Journal
Volume36
Issue number21
DOIs
StatePublished - 1 Jun 2015

Keywords

  • Aortic stenosis
  • Heart valve failure
  • Prosthetic valve endocarditis
  • Transcatheter aortic valve implantation
  • Transcatheter heart valve failure

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