February 8, 2026Circulation Cardiovascular Interventions3 citations
View Full PaperCardiac Structural Complications Following TAVR
Key Result
Cardiac structural complications occurred in 2.1% of TAVR patients, with 35.3% 30-day mortality and 27.6% requiring surgery, rates stable over 10 years.
Key Points
- The study aims to evaluate the incidence, timing, management, and clinical impact of cardiac structural complications following TAVR.
- Conducted a multicenter analysis of patients undergoing TAVR across 18 centers in Europe and Canada from 2014 to 2024.
- Identified cardiac structural complications based on Valve Academic Research Consortium 3 criteria.
- Collected patient data and followed-up at 30 days, 1 year, and annually after TAVR.
- Cardiac structural complications occurred in 221 out of 10,541 patients (2.1%), with 126 patients experiencing more than one complication.
- Major complications included annular rupture (41.1%), left ventricular perforation (26.0%), and new pericardial effusions (1.4%).
- Thirty-day mortality rate was 35.3%, with significantly higher rates among patients requiring surgical conversion.
Structured PICO
What is the incidence, management, and clinical impact of cardiac structural complications following transcatheter aortic valve replacement?
P
Population
10,541 consecutive patients undergoing transcatheter aortic valve replacement (TAVR) across 18 European and Canadian centers from 2014 to 2024.
I
Intervention
Transcatheter aortic valve replacement (TAVR)
O
Outcome
Incidence, timing, management, and clinical impact of Cardiac Structural Complications (CSCs) as defined by Valve Academic Research Consortium 3 (VARC-3) criteriasafety
Cardiac structural complications following TAVR occur in approximately 2% of patients, have not decreased over the last decade, and are associated with high rates of surgical conversion and 30-day mortality.
Main Result
Absolute Event Rate: 0% vs 0%
Abstract
BACKGROUND: Cardiac structural complications (CSCs) have been recently established by the Valve Academic Research Consortium 3 consensus as a combined end point including multiple life-threatening periprocedural events following transcatheter aortic valve replacement. The objective was to assess the incidence, timing, management, and clinical impact of CSCs in the contemporary transcatheter aortic valve replacement era. METHODS: Multicenter study including consecutive patients undergoing transcatheter aortic valve replacement in 18 European and Canadian centers from 2014 to 2024. According to the Valve Academic Research Consortium 3 criteria, CSCs included cardiac structure perforation, injury or compromise, new pericardial effusion, and coronary obstruction. Data was collected in a dedicated database, and patients were followed at 30 days, 1 year, and yearly thereafter. RESULTS: Among a total of 10 541 patients, CSCs occurred in 221 (2.1%), with 126 (1.2%) patients exhibiting >1 CSC: 146 (1.4%) cardiac structure compromise events (annular rupture: 41.1%, left ventricular perforation: 26.0%; right ventricular perforation: 24.0%, other injuries: 8.9%), 150 (1.4%) new pericardial effusions, and 59 (0.6%) coronary obstructions. Up to 75.6% of CSCs occurred intraprocedurally, and 61 (27.6%) patients had conversion to open heart surgery. The incidence of CSCs remained similar throughout the 10-year study period (from 1.3% to 3.2%, median annual rate of 2.3%). Thirty-day mortality was 35.3% (47.5% among patients requiring conversion to surgery), with annular rupture associated with the highest (41.0%) mortality rate. CONCLUSIONS: About 2% of contemporary transcatheter aortic valve replacement recipients presented CSCs, which did not decrease over time, required conversion to surgery in more than one-fourth of cases, and were associated with very high periprocedural mortality rates. Further research is needed regarding potential preventive strategies and optimal surgical bailout management.