Severe intraprocedural complications after transcatheter aortic valve implantation: calling for a heart team approach

A retrospective study characterizing "severe intraprocedural complications" during TAVR "requiring immediate surgical or interventional bailout manoeuvres."  Analysis of 458 consecutive TAVR patients through transfemoral and transapical approaches. Complications requiring intraoperative bailout manoeuvres were analysed according to the Valve Academic Research Consortium (VARC) criteria.   40 major intraprocedural complications occurred in 35 patients  (7.6%), including conversion to surgery for valve embolization/migration (17%), severe aortic regurgitation (12%) and root rupture (5%); need for surgical haemostasis secondary to left ventricular wire perforation and subsequent cardiac tamponade; and percutaneous coronary intervention in 6 patients.  All-cause mortality at 30 days was 31.4% in patients with intraprocedural complications and 38.5% in patients requiring surgical conversion.   The authors conclude that an interdisciplinary heart-term approach creates "a surgical and interventional safety net" that facilitated bailout strategies in the setting of severe intraprocedural complications.