Key result
Emergent surgical aortic valve replacement successfully treated two cases of acute heart failure caused by sudden transcatheter aortic valve leaflet dehiscence 6 years after primary TAVR.
Why the study?
Although TAVR is less invasive with good early results, the long-term durability of the transcatheter aortic valve remains unclear.
Case Report (n=2)
This report highlights a rare but severe late complication of TAVR—sudden leaflet dehiscence—raising concerns about the long-term durability and safety of transcatheter valves.
Late TAVR dehiscence may precipitate acute HF; leaves open durability questions beyond 7 years.
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has caused a paradigm shift in the treatment of severe aortic stenosis. Although less invasive and good early results of TAVR have been reported, the long-term durability of the transcatheter aortic valve is still unclear. CASE PRESENTATION: We performed an emergent surgical aortic valve replacement (SAVR) for two cases of acute heart failure due to sudden transcatheter aortic valve dehiscence after 7 or 6 years of primary TAVR. In both cases, transthoracic echocardiography revealed severe transvalvular regurgitation of the transcatheter aortic valve. Intraoperative findings revealed dehiscence on both sides of the anatomical non-coronary cusp without evident signs of degeneration, such as thickening, calcification, or infection. The postoperative course of the cases was uneventful, and the patients were discharged home on days 20 and 48 after the reoperation. CONCLUSIONS: Although the cause of the valvular disease is unknown, we are seriously concerned that the number of similar cases will increase in the future. We should be cautious in expanding the application of TAVR without evidence of long-term safety.
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Arai et al. (2022) conducted a case report in Sudden leaflet dehiscence after transcatheter aortic valve replacement (n=2). Emergent surgical aortic valve replacement was evaluated on Postoperative recovery and discharge. Emergent surgical aortic valve replacement successfully treated two cases of acute heart failure caused by sudden transcatheter aortic valve leaflet dehiscence 6 years after primary TAVR.
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