Incidence and outcome of peri-procedural transcatheter heart valve embolization and migration: the TRAVEL registry (TranscatheteR HeArt Valve EmboLization and Migration)

Kim WK, Schäfer U, Tchetche D, Nef H, Avanzas P, Rudolph T, Scholtz S, Barbanti M, Kempfert J, Mangieri A, Lauten A, Frerker C, Yoon SH, Holzamer A, Praz F, De Backer O, Toggweiler S, Blumenstein J, Purita P, Tarantini G, Thilo C, Wolf A, Husser O, Pellegrini C, Burgdorf C, Antolin RAH, Díaz VA, Liebetrau C, Schofer N, Möllmann H, Eggebrecht H, Sondergaard L, Walther T, Pilgrim T, Hilker M, Makkar R, Unbehaun A, Börgermann J, Moris C, Achenbach S, Dörr O, Brochado B, Conradi L, Hamm CW, Arnold M (2019)

Publication Type: Journal article

Publication year: 2019

Journal

Book Volume: 40

Pages Range: 3156-3165

Journal Issue: 38

DOI: 10.1093/eurheartj/ehz429

Abstract

AIMS: Peri-procedural transcatheter valve embolization and migration (TVEM) is a rare but potentially devastating complication of transcatheter aortic valve implantation (TAVI). We sought to assess the incidence, causes, and outcome of TVEM in a large multicentre cohort. METHODS AND RESULTS: We recorded cases of peri-procedural TVEM in patients undergoing TAVI between January 2010 and December 2017 from 26 international sites. Peri-procedural TVEM occurred in 273/29 636 (0.92%) TAVI cases (age 80.8 ± 7.3 years; 53.8% female), of which 217 were to the ascending aorta and 56 to the left ventricle. The use of self-expanding or first-generation prostheses and presence of a bicuspid aortic valve were independent predictors of TVEM. Bail-out measures included repositioning attempts using snares or miscellaneous tools (41.0%), multiple valve implantations (83.2%), and conversion to surgery (19.0%). Using 1:4-propensity matching, we identified a cohort of 235 patients with TVEM (TVEMPS) and 932 patients without TVEM (non-TVEMPS). In the matched cohort, all-cause mortality was higher in TVEMPS than in non-TVEMPS at 30 days (18.6% vs. 4.9%; P < 0.001) and after 1 year (30.5% vs. 16.6%; P < 0.001). Major stroke was more frequent in TVEMPS at 30 days (10.6% vs. 2.8%; P < 0.001), but not at 1 year (4.6% vs. 1.9%; P = 0.17). The need for emergent cardiopulmonary support, major stroke at 30 days, and acute kidney injury Stages 2 and 3 increased the risk of 1-year mortality, whereas a better renal function at baseline was protective. CONCLUSION: Transcatheter valve embolization and migration occurred in approximately 1% and was associated with increased morbidity and mortality.

Authors with CRIS profile

Involved external institutions

Kerckhoff-Klinik Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Clinique Pasteur France (FR) Justus-Liebig-Universität Gießen Germany (DE) Central University Hospital of Asturias Spain (ES) Universität zu Köln Germany (DE) Herz- und Diabeteszentrum Nordrhein-Westfalen Germany (DE) Università degli Studi di Catania Italy (IT) Deutsches Herzzentrum Berlin Germany (DE) Ospedale San Raffaele (früher: Centro San Raffaele del Monte Tabor Foundation) Italy (IT) Charité - Universitätsmedizin Berlin Germany (DE) Asklepios Kliniken Germany (DE) Cedars-Sinai Medical Center United States (USA) (US) Universitätsklinikum Regensburg Germany (DE) Inselspital, Universitätsspital Bern Switzerland (CH) University of Copenhagen Denmark (DK) Luzerner Kantonsspital (LUKS) Switzerland (CH) St.-Johannes-Hospital Germany (DE) University of Padua / Universita degli Studi di Padova Italy (IT) Universitätsklinikum Augsburg Germany (DE) Elisabeth-Krankenhaus Essen Germany (DE) Technische Universität München (TUM) Germany (DE) Herz- und Gefäßzentrum Bad Bevensen Germany (DE) Hospital Universitario Ramón y Cajal Spain (ES) University Hospital Complex Of Vigo / Complejo Hospitalario Universitario de Vigo (CHUVI) Spain (ES) Cardioangiologische Centrum Bethanien Germany (DE)

How to cite

APA:

Kim, W.K., Schäfer, U., Tchetche, D., Nef, H., Avanzas, P., Rudolph, T.,... Arnold, M. (2019). Incidence and outcome of peri-procedural transcatheter heart valve embolization and migration: the TRAVEL registry (TranscatheteR HeArt Valve EmboLization and Migration). European Heart Journal, 40(38), 3156-3165. https://doi.org/10.1093/eurheartj/ehz429

MLA:

Kim, Won Keun, et al. "Incidence and outcome of peri-procedural transcatheter heart valve embolization and migration: the TRAVEL registry (TranscatheteR HeArt Valve EmboLization and Migration)." European Heart Journal 40.38 (2019): 3156-3165.

BibTeX: Download