Post-mortem computed tomography and post-mortem computed tomography angiography following transcatheter aortic valve implantation†

OBJECTIVES: At present, transcatheter aortic valve implantation (TAVI) is widely used. As with any interventional treatment, however, TAVI may also be accompanied by complications and may result in periprocedural mortality. This study aims to evaluate such complications and causes of death after TAVI.

METHODS: The study included 32 deceased (59.4% female, n = 19, median age: 82 years) patients with TAVI, since 2008, in whom post-mortem computed tomography (PMCT) and PMCT angiography were performed with the intention of identifying complications.

RESULTS: Altogether, we registered bleeding (28.1%, 9/32), perforation and rupture (25%, 8/32), cerebral infarction (18.8%, 6/32), injury of the conduction system (3.1%, 1/32), insufficiency of the aortic (12.5%, 4/32) and the mitral valve (9.4%, 3/32) and of valve-in-valve procedures (9.4%, 3/32). Furthermore, there were findings due to cardiopulmonary resuscitation and intensive care. PMCT and PMCT angiography has advantages over autopsy. The demonstration of bleeding vessels, ruptures, the position of the implanted aortic valve and its effects on the mitral valve and its suspensions were more easily accessible by computed tomography-imaging display than by customary autopsy photo-documentation.

CONCLUSIONS: After TAVI, PMCT and PMCT angiography successfully demonstrated the complications leading to death. PMCT and PMCT angiography contribute to the post-mortem analysis of causes of periprocedural death.