Incidence and Prognosis of Heart Valve Embolization

The incidence of peri-procedural transcatheter heart valve embolization and migration (TVEM) is as low as 1%. However, it is associated with increased morbidity and mortality.

Trombólisis local en tromboembolismo pulmonar

Peri-procedural TVEM is one of the most feared complication given its potential to transform the procedure into a catastrophe, but little do we know about its incidence (except for a few reports from one single center) or, more importantly, its impact in patient prognosis. 

This study recently published in the European Heart Journal sheds some light on this event, since it assessed a large cohort of patients treated in 26 internationally renowned centers.

Between 2010 and 2017 TVEM occurred in 273 patients (0.92% of the entire cohort), 217 to the ascending aorta and 56 to the left ventricle. The use of the self-expandable prosthesis, 1st gen devices and bicuspid valves were the independent predictors of TVEM.


Read also: Trying to Reduce Post TAVR Kidney Injury.


Bail-out maneuvers to prevent a definite catastrophe included the use of snares (41%), implanting a second valve (83.2%) and conversion to surgery (19%).

Using propensity score, researchers were able to match 1:4 a cohort of 235 patients presenting TVME and another cohort of 932 patients who did not present TVME. The first group showed increased all-cause mortality at 30 days (18.6% vs 4.9%; p<0.001) and one year (30.5% vs. 16.6%; p<0.001). Something similar happened with stroke at 30 days (10.6% vs. 2.8%; p<0.001), but not at one year. 

The need for emergency cardiovascular support, major stroke at 30 days and kidney injury increased mortality risk at one year, while a good kidney function at baseline was protective. 

Conclusion

Peri-procedural TVME has around 1% incidence and is associated with significant mortality and morbidity incresase.

Original title: Incidence and outcome of peri-procedural transcatheter heart valve embolization and migration: the TRAVEL registry (TranscatheteR HeArt Valve EmboLization And Migration).

Reference: Won-Keun Kim et al. European Heart Journal (2019) 40, 3156–3165.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...

TAVR in Young Low-Risk Patients

Transcatheter aortic valve replacement (TAVR) has established itself as an effective strategy for the treatment of severe aortic stenosis across different risk groups. While previous...

TAVR and Atrial Fibrillation: What Anticoagulants Should We Use?

The prevalence of atrial fibrillation (AF) in TAVR patients ranges from 15 to 30%, depending on series. This arrhythmia has been associated to higher...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...