A systematic review of 87 cases of transcatheter heart valve failure identified typical failure modes like endocarditis (n=34) and thrombosis (n=15), plus unique modes like late embolization (n=18).
Systematic Review (n=87)
What are the aetiology, diagnosis, management, and outcomes of transcatheter heart valve failure?
Transcatheter heart valves are susceptible to failure modes typical of surgical bioprostheses (endocarditis, structural failure, thrombosis) as well as unique complications like late embolization and compression following CPR.
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. Two novel causes of THV failure were identified: late THV embolization (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.
Mylotte et al. (Sun,) conducted a systematic review in Transcatheter heart valve failure (n=87). Transcatheter heart valve implantation was evaluated on Aetiology, diagnosis, management, and outcomes of THV failure. A systematic review of 87 cases of transcatheter heart valve failure identified typical failure modes like endocarditis (n=34) and thrombosis (n=15), plus unique modes like late embolization (n=18).