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

TY - JOUR

T1 - Incidence and outcome of peri-procedural transcatheter heart valve embolization and migration: the TRAVEL registry (TranscatheteR HeArt Valve EmboLization and Migration)

AU - Kim, Won-Keun

AU - Schäfer, Ulrich

AU - Tchetche, Didier

AU - Nef, Holger

AU - Arnold, Martin

AU - Avanzas, Pablo

AU - Rudolph, Tanja

AU - Scholtz, Smita

AU - Barbanti, Marco

AU - Kempfert, Jörg

AU - Mangieri, Antonio

AU - Lauten, Alexander

AU - Frerker, Christian

AU - Yoon, Sung-Han

AU - Holzamer, Andreas

AU - Praz, Fabien

AU - De Backer, Ole

AU - Toggweiler, Stefan

AU - Blumenstein, Johannes

AU - Purita, Paola

AU - Tarantini, Giuseppe

AU - Thilo, Christian

AU - Wolf, Alexander

AU - Husser, Oliver

AU - Pellegrini, Costanza

AU - Burgdorf, Christof

AU - Antolin, Rosa Ana Hernandez

AU - Díaz, Victor A Jiménez

AU - Liebetrau, Christoph

AU - Schofer, Niklas

AU - Möllmann, Helge

AU - Eggebrecht, Holger

AU - Sondergaard, Lars

AU - Walther, Thomas

AU - Pilgrim, Thomas

AU - Hilker, Michael

AU - Makkar, Raj

AU - Unbehaun, Axel

AU - Börgermann, Jochen

AU - Moris, Cesar

AU - Achenbach, Stephan

AU - Dörr, Oliver

AU - Brochado, Bruno

AU - Conradi, Lenard

AU - Hamm, Christian W

N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.

PY - 2019/10/7

Y1 - 2019/10/7

N2 - 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.

AB - 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.

KW - Aged

KW - Aged, 80 and over

KW - Embolism/epidemiology

KW - Female

KW - Heart Valve Prosthesis/adverse effects

KW - Humans

KW - Incidence

KW - Male

KW - Postoperative Complications/epidemiology

KW - Prosthesis Failure/adverse effects

KW - Registries

KW - Retrospective Studies

KW - Risk Factors

KW - Stroke/epidemiology

KW - Transcatheter Aortic Valve Replacement/adverse effects

KW - Treatment Outcome

U2 - 10.1093/eurheartj/ehz429

DO - 10.1093/eurheartj/ehz429

M3 - SCORING: Journal article

C2 - 31230081

VL - 40

SP - 3156

EP - 3165

JO - EUR HEART J

JF - EUR HEART J

SN - 0195-668X

IS - 38

ER -