Incidence and outcome of peri-procedural transcatheter heart valve embolization and migration: The TRAVEL registry (TranscatheteR HeArt Valve EmboLization and Migration)

Won Keun Kim*, Ulrich Schäfer, Didier Tchetche, Holger Nef, Martin Arnold, Pablo Avanzas, Tanja Rudolph, Smita Scholtz, Marco Barbanti, Jörg Kempfert, Antonio Mangieri, Alexander Lauten, Christian Frerker, Sung Han Yoon, Andreas Holzamer, Fabien Praz, Ole De Backer, Stefan Toggweiler, Johannes Blumenstein, Paola PuritaGiuseppe Tarantini, Christian Thilo, Alexander Wolf, Oliver Husser, Costanza Pellegrini, Christof Burgdorf, Rosa Ana Hernandez Antolin, Victor A.Jiménez Díaz, Christoph Liebetrau, Niklas Schofer, Helge Möllmann, Holger Eggebrecht, Lars Sondergaard, Thomas Walther, Thomas Pilgrim, Michael Hilker, Raj Makkar, Axel Unbehaun, Jochen Börgermann, Cesar Moris, Stephan Achenbach, Oliver Dörr, Bruno Brochado, Lenard Conradi, Christian W. Hamm

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

112 Citations (Scopus)

Abstract

Aims: Peri-procedural transcatheter valve embolization and migration (TVEM) is a rare but potentially devastating complication of transcatheter aortic valve implantation (TAVI). We sought to assess the incidence, causes, and outcome of TVEM in a large multicentre cohort. Methods and results: We recorded cases of peri-procedural TVEM in patients undergoing TAVI between January 2010 and December 2017 from 26 international sites. Peri-procedural TVEM occurred in 273/29 636 (0.92%) TAVI cases (age 80.8 ± 7.3 years; 53.8% female), of which 217 were to the ascending aorta and 56 to the left ventricle. The use of self-expanding or first-generation prostheses and presence of a bicuspid aortic valve were independent predictors of TVEM. Bail-out measures included repositioning attempts using snares or miscellaneous tools (41.0%), multiple valve implantations (83.2%), and conversion to surgery (19.0%). Using 1:4-propensity matching, we identified a cohort of 235 patients with TVEM (TVEMPS) and 932 patients without TVEM (non-TVEMPS). In the matched cohort, all-cause mortality was higher in TVEMPS than in non-TVEMPS at 30 days (18.6% vs. 4.9%; P < 0.001) and after 1 year (30.5% vs. 16.6%; P < 0.001). Major stroke was more frequent in TVEMPS at 30 days (10.6% vs. 2.8%; P < 0.001), but not at 1 year (4.6% vs. 1.9%; P = 0.17). The need for emergent cardiopulmonary support, major stroke at 30 days, and acute kidney injury Stages 2 and 3 increased the risk of 1-year mortality, whereas a better renal function at baseline was protective. Conclusion: Transcatheter valve embolization and migration occurred in approximately 1% and was associated with increased morbidity and mortality.

Original languageEnglish
JournalEuropean Heart Journal
Volume40
Issue number38
Pages (from-to)3156-3165
Number of pages10
ISSN0195-668X
DOIs
Publication statusPublished - 2019

Keywords

  • Aortic stenosis
  • Conversion
  • Embolization
  • Migration
  • Prosthesis
  • TAVR
  • Valve-in-valve

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