Key result
Conservative management with anticoagulation and serial echocardiography may be appropriate in post-TAVR aortic valve leaflet avulsion cases without ischemic or embolic manifestations.
Why the study?
Aortic valve leaflet avulsion is a life-threatening adverse event after transcatheter aortic valve replacement, but literature on this complication remains limited.
Case Report (n=11)
Conservative management with anticoagulation and surveillance may be a safe and appropriate strategy for post-TAVR aortic valve leaflet avulsion in selected patients without hemodynamic instability or embolic manifestations.
BACKGROUND: Aortic valve leaflet avulsion (AVLA) is recognized as a life-threatening adverse event that significantly affects patient hemodynamics, often leading to additional intervention. CASE SUMMARY: We report 2 cases from our institution of AVLA after transcatheter aortic valve replacement (TAVR). The patients had a highly mobile mass on the aortic annulus and the left ventricular outflow tract, respectively. DISCUSSION: In both cases, a multidisciplinary team discussion resulted in the decision to monitor the patients for 48 hours for neurovascular changes while on therapeutic anticoagulation, and both patients were discharged on anticoagulants and low-dose aspirin. Their hospital courses were uneventful, and normally functional aortic valve bioprostheses were noted on follow-up. BEYOND THE GUIDELINES: The literature on AVLA after TAVR remains limited. The current treatment approaches for AVLA are primarily invasive, including surgical repair of the valve or snaring of avulsed structures. TAKE-HOME MESSAGE: Conservative management may be appropriate in post-TAVR AVLA cases without ischemic or embolic manifestation.
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Abusulb et al. (2025) conducted a case report in Aortic Valve Leaflet Avulsion (AVLA) after TAVR (n=11). Conservative medical management vs. Surgical removal or percutaneous snaring was evaluated. Conservative management with anticoagulation and serial echocardiography may be appropriate in post-TAVR aortic valve leaflet avulsion cases without ischemic or embolic manifestations.
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