Alan Wilson and Szeto Zajarias show that vascular complications of the trans-femoral path remain an important factor because of the high profile of the catheters used in TAVI and the appearance of smaller devices, as well as the experience of surgeons, will progressively reduce complication rates.
Josep Rodes-Cabau commented about the negative impact a stroke has over the procedure and prevention strategies for embolism that are being developed to reduce the incidence of periprocedural stroke.
Thomas Gleason was devoted to the incidence and impact of post-procedural paravalvular aortic regurgitation (AR), showing that moderate aortic regurgitation was found in 24.7% of patients and that is an independent predictor of mortality both in the short term and long term. This can be corrected by post dilatation or implantation of a second prosthesis.
Samir Kapadia R., commented on coronary occlusion that may occur during delivery of the stent, a rare complication, (0.6 to 1%), but potentially fatal.
Philippe Genereux addressed the defective position, migration and device embolization. Although rare, (1.7% of cases), this complication increases morbidity and mortality and can lead to coronary obstruction, severe aortic failure, conduction disturbances, strokes, aortic dissection, vascular complications and bleeding. Embolization is most common when the procedure is performed trans-femoral versus trans-apical. He concludes that it is essential to plan with an imaging procedure to decrease the rate of embolization and defective position. New devices will significantly reduce the rate of this complication.
This session demonstrated how the complications of TAVI impact on prognosis over the short-term and long term due to the profile of patients, the severity of these complications, the preoperative preparation procedure, the choice of prosthesis with all measures taken (preferably by more than one method), the experience of professionals in this procedure and knowledge of the anatomy of the femoral and iliac aorta area to choose ideal access thus leading to a decrease in these complications and an ever improving performance.
2013-03-09
