Potential complications of transcatheter aortic valve implantation (TAVI)-an autopsy perspective.

OBJECTIVE: Degenerative or post-endocarditic destruction of aortic valves with secondary left ventricular hypertension and cardiac insufficiency is seen more frequently in patients of increasing age. When conventional aortic valve replacement is no longer an option, because of age and co-morbidity, patients are increasingly treated with interventional aortic valve replacement using transcatheter aortic valve implantation (TAVI).

METHODS AND RESULTS: TAVI has been performed in Cologne since 2008. We screened our autopsy registry for cases of TAVI, identifying and characterizing complications in connection with the TAVI procedure. We found 13 patients who underwent TAVI procedure. Five of these patients died of non-TAVI specific postoperative complications, whereas in 8 patients there was a direct relationship between TAVI complications and the cause of death. The Patients died within hours and few days after TAVI procedure respectively. Problems observed included predominantly complications due to calcifications of the aortic valve cusps as well as acute endocarditis in 20% of cases. In one case there was an irreversible compression of the implanted valve due to cardiac resuscitation and a malposition of the bioprosthesis.

CONCLUSIONS: Future improvements of preoperative evaluation, especially concerning the degree of calcifications of the aortic valve, appear necessary to increase the chance of preventing such complications. Until then, autopsy analysis of complications may help to improve the TAVI procedure.