Progress in the care of complications after transcatheter aortic valve replacement_West China Medical Journal

Authors：

LIU Jinchun ¹ ,  ZHU Yu ² , YANG Wenqian ² , XIANG Luan ² , XU Guihua ²

1. School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei 430065, P. R. China;
2. Department of Cardiothoracic Surgery, General Hospital of Central Theater Command, Wuhan, Hubei 430070, P. R. China;

Corresponding author：

ZHU Yu, Email: XXWKZY@163.com

Keywords：

Transcatheter aortic valve replacement; aortic stenosis; complication care

DOI：

10.7507/1002-0179.202210206

Video：

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In recent years, heart valve disease has been increasing year by year. Transcatheter aortic valve replacement (TAVR) has become the first-line surgical method for patients with severe aortic stenosis due to the advantages of small surgical trauma and rapid postoperative recovery. In the context of the rapid development of TAVR, the postoperative complications of TAVR seriously affect the surgical success rate and patient prognosis. Therefore, the prevention and nursing of complications after TAVR are particularly important. This article will review the assessment, prevention and care of the complications such as arrhythmia, vascular complications, perivalvular leakage, stroke, and acute renal failure after TAVR in combination with the current situation at home and abroad, in order to enhance the clinical medical workers’ understanding of the complications.

Citation： LIU Jinchun, ZHU Yu, YANG Wenqian, XIANG Luan, XU Guihua. Progress in the care of complications after transcatheter aortic valve replacement. West China Medical Journal, 2023, 38(6): 947-951. doi: 10.7507/1002-0179.202210206 Copy

1.	Arora S, Misenheimer JA, Ramaraj R. Transcatheter aortic valve replacement: comprehensive review and present status. Tex Heart Inst J, 2017, 44(1): 29-38.
2.	党梦秋, 范嘉祺, 朱齐丰, 等. 《经导管主动脉瓣置换术中国专家共识 (2020 更新版)》解读. 心电与循环, 2021, 40(1): 1-5.
3.	中国医师协会心血管内科医师分会结构性心脏病专业委员会. 经导管主动脉瓣置换术中国专家共识 (2020 更新版). 中国介入心脏病学杂志, 2020, 28(6): 301-309.
4.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation, 2021, 143(5): e35-e71.
5.	Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J, 2012, 33(19): 2451-2496.
6.	UK TAVI Trial Investigators, Toff WD, Hildick-Smith D, et al. Effect of transcatheter aortic valve implantation vs surgical aortic valve replacement on all-cause mortality in patients with aortic stenosis: a randomized clinical trial. JAMA, 2022, 327(19): 1875-1887.
7.	Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med, 2019, 380(18): 1706-1715.
8.	Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
9.	葛均波, 周达新, 潘文志, 等. 经皮主动脉瓣植入术一例及其操作要点. 中国介入心脏病学杂志, 2010, 18(5): 243-246.
10.	Liao YB, Zhao ZG, Wei X, et al. Transcatheter aortic valve implantation with the self-expandable venus a-valve and corevalve devices: preliminary experiences in China. Catheter Cardiovasc Interv, 2017, 89(S1): 528-533.
11.	中国医师协会心血管内科医师分会结构性心脏病专业委员会, 中华医学会心血管病学分会结构性心脏病学组. 经导管主动脉瓣置换术中国专家共识. 中国介入心脏病学杂志, 2015, 23(12): 661-667.
12.	经导管主动脉瓣置换术流程优化共识专家组. 经导管主动脉瓣置换术 (TAVR) 流程优化专家共识 2022 版. 中华急诊医学杂志, 2022, 31(2): 154-160.
13.	Tarantini G, Mojoli M, Windecker S, et al. Prevalence and impact of atrial fibrillation in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: an analysis from the SOURCE XT prospective multicenter registry. JACC Cardiovasc Interv, 2016, 9(9): 937-946.
14.	Yoon YH, Ahn JM, Kang DY, et al. Incidence, predictors, management, and clinical significance of new-onset atrial fibrillation after transcatheter aortic valve implantation. Am J Cardiol, 2019, 123(7): 1127-1133.
15.	Thirumala PD, Muluk S, Udesh R, et al. Carotid artery disease and periprocedural stroke risk after transcatheter aortic valve implantation. Ann Card Anaesth, 2017, 20(2): 145-151.
16.	Williams JV, Flynn Magic MB. Postoperative care for transcatheter aortic valve replacement. J Perianesth Nurs, 2019, 34(2): 431-434.
17.	Mazzella AJ, Sanders M, Yang H, et al. Predicting need for pacemaker implantation early and late after transcatheter aortic valve implantation. Catheter Cardiovasc Interv, 2021, 97(4): E588-E596.
18.	Auffret V, Puri R, Urena M, et al. Conduction disturbances after transcatheter aortic valve replacement: current status and future perspectives. Circulation, 2017, 136(11): 1049-1069.
19.	Winter JL, Healey JS, Sheth TN, et al. Remote ambulatory cardiac monitoring before and after transcatheter aortic valve replacement. CJC Open, 2020, 2(5): 416-419.
20.	Toggweiler S, Leipsic J, Binder RK, et al. Management of vascular access in transcatheter aortic valve replacement: Part 2: vascular complications. JACC Cardiovasc Interv, 2013, 6(8): 767-776.
21.	Généreux P, Head SJ, Van Mieghem NM, et al. Clinical outcomes after transcatheter aortic valve replacement using valve academic research consortium definitions: a weighted meta-analysis of 3, 519 patients from 16 studies. J Am Coll Cardiol, 2012, 59(25): 2317-2326.
22.	Wang J, Yu W, Jin Q, et al. Risk factors for post-TAVI bleeding according to the VARC-2 bleeding definition and effect of the bleeding on short-term mortality: a meta-analysis. Can J Cardiol, 2017, 33(4): 525-534.
23.	王昌进, 罗淞元, 李捷. 经导管主动脉瓣置换术入路及血管并发症的研究现状. 华西医学, 2021, 36(9): 1177-1183.
24.	Beurtheret S, Karam N, Resseguier N, et al. Femoral versus nonfemoral peripheral access for transcatheter aortic valve replacement. J Am Coll Cardiol, 2019, 74(22): 2728-2739.
25.	孙英皓, 李捷, 郑胜能, 等. 经导管主动脉瓣置换术并发冠状动脉堵塞及腹膜后血肿一例. 华西医学, 2020, 35(9): 1131-1134.
26.	Paradis JM, Altisent OA, RodÉs-Cabau J. Reducing periprocedural complications in transcatheter aortic valve replacement: review of paravalvular leaks, stroke, and vascular complications. Expert Rev Cardiovasc Ther, 2015, 13(11): 1251-1262.
27.	邢超凡, 潘欣, 何奔. 外科瓣膜置换术后瓣周漏相关性溶血的机制探讨及介入治疗进展. 中国介入心脏病学杂志, 2023, 31(2): 142-145.
28.	Armijo G, Nombela-Franco L, Tirado-Conte G. Cerebrovascular events after transcatheter aortic valve implantation. Front Cardiovasc Med, 2018, 5: 104.
29.	Tchetche D, Farah B, Misuraca L, et al. Cerebrovascular events post-transcatheter aortic valve replacement in a large cohort of patients: a FRANCE-2 registry substudy. JACC Cardiovasc Interv, 2014, 7(4): 1138-1145.
30.	Kapadia SR, Kodali S, Makkar R, et al. Protection against cerebral embolism during transcatheter aortic valve replacement. J Am Coll Cardiol, 2017, 69(4): 367-377.
31.	Fefer P, Bogdan A, Grossman Y, et al. Impact of rapid ventricular pacing on outcome after transcatheter aortic valve replacement. J Am Heart Assoc, 2018, 7(14): e009038.
32.	Valtra W, Jimenez-Quevedo P, Tchétché D, et al. Predictors, incidence, and outcomes of patients undergoing transfemoral transcatheter aortic valve implantation complicated by stroke. Circ Cardiovasc Interv, 2019, 12(3): e007546.
33.	朱嘉俊, 赵倩, 李晓梅, 等. 经导管主动脉瓣置换术相关脑卒中及脑栓塞保护装置的研究现状. 华西医学, 2021, 36(9): 1161-1166.
34.	杨玉, 李榕彬, 刘春雪. 经导管主动脉瓣置换术患者二例的护理. 解放军护理杂志, 2012, 29(6): 37-39.
35.	Zaleska-Kociecka M, Dabrowski M, Stepinska J. Acute kidney injury after transcatheter aortic valve replacement in the elderly: outcomes and risk management. Clin Interv Aging, 2019, 14: 195-201.
36.	张倩, 张文佳, 王墨扬, 等. 经导管主动脉瓣置换术后急性肾损伤的发生及危险因素的分析. 中国循环杂志, 2019, 34(11): 1079-1084.
37.	Ram P, Mezue K, Pressman G, et al. Acute kidney injury post-transcatheter aortic valve replacement. Clin Cardiol, 2017, 40(12): 1357-1362.
38.	Strauch JT, Scherner MP, Haldenwang PL, et al. Minimally invasive transapical aortic valve implantation and the risk of acute kidney injury. Ann Thorac Surg, 2010, 89(2): 465-470.
39.	张春, 蔡闵敏, 王海霞, 等. 经导管主动脉瓣膜置换术复杂高危患者围手术期护理管理策略. 中国继续医学教育, 2021, 13(9): 182-185.

1. Arora S, Misenheimer JA, Ramaraj R. Transcatheter aortic valve replacement: comprehensive review and present status. Tex Heart Inst J, 2017, 44(1): 29-38.
2. 党梦秋, 范嘉祺, 朱齐丰, 等. 《经导管主动脉瓣置换术中国专家共识 (2020 更新版)》解读. 心电与循环, 2021, 40(1): 1-5.
3. 中国医师协会心血管内科医师分会结构性心脏病专业委员会. 经导管主动脉瓣置换术中国专家共识 (2020 更新版). 中国介入心脏病学杂志, 2020, 28(6): 301-309.
4. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation, 2021, 143(5): e35-e71.
5. Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J, 2012, 33(19): 2451-2496.
6. UK TAVI Trial Investigators, Toff WD, Hildick-Smith D, et al. Effect of transcatheter aortic valve implantation vs surgical aortic valve replacement on all-cause mortality in patients with aortic stenosis: a randomized clinical trial. JAMA, 2022, 327(19): 1875-1887.
7. Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med, 2019, 380(18): 1706-1715.
8. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
9. 葛均波, 周达新, 潘文志, 等. 经皮主动脉瓣植入术一例及其操作要点. 中国介入心脏病学杂志, 2010, 18(5): 243-246.
10. Liao YB, Zhao ZG, Wei X, et al. Transcatheter aortic valve implantation with the self-expandable venus a-valve and corevalve devices: preliminary experiences in China. Catheter Cardiovasc Interv, 2017, 89(S1): 528-533.
11. 中国医师协会心血管内科医师分会结构性心脏病专业委员会, 中华医学会心血管病学分会结构性心脏病学组. 经导管主动脉瓣置换术中国专家共识. 中国介入心脏病学杂志, 2015, 23(12): 661-667.
12. 经导管主动脉瓣置换术流程优化共识专家组. 经导管主动脉瓣置换术 (TAVR) 流程优化专家共识 2022 版. 中华急诊医学杂志, 2022, 31(2): 154-160.
13. Tarantini G, Mojoli M, Windecker S, et al. Prevalence and impact of atrial fibrillation in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: an analysis from the SOURCE XT prospective multicenter registry. JACC Cardiovasc Interv, 2016, 9(9): 937-946.
14. Yoon YH, Ahn JM, Kang DY, et al. Incidence, predictors, management, and clinical significance of new-onset atrial fibrillation after transcatheter aortic valve implantation. Am J Cardiol, 2019, 123(7): 1127-1133.
15. Thirumala PD, Muluk S, Udesh R, et al. Carotid artery disease and periprocedural stroke risk after transcatheter aortic valve implantation. Ann Card Anaesth, 2017, 20(2): 145-151.
16. Williams JV, Flynn Magic MB. Postoperative care for transcatheter aortic valve replacement. J Perianesth Nurs, 2019, 34(2): 431-434.
17. Mazzella AJ, Sanders M, Yang H, et al. Predicting need for pacemaker implantation early and late after transcatheter aortic valve implantation. Catheter Cardiovasc Interv, 2021, 97(4): E588-E596.
18. Auffret V, Puri R, Urena M, et al. Conduction disturbances after transcatheter aortic valve replacement: current status and future perspectives. Circulation, 2017, 136(11): 1049-1069.
19. Winter JL, Healey JS, Sheth TN, et al. Remote ambulatory cardiac monitoring before and after transcatheter aortic valve replacement. CJC Open, 2020, 2(5): 416-419.
20. Toggweiler S, Leipsic J, Binder RK, et al. Management of vascular access in transcatheter aortic valve replacement: Part 2: vascular complications. JACC Cardiovasc Interv, 2013, 6(8): 767-776.
21. Généreux P, Head SJ, Van Mieghem NM, et al. Clinical outcomes after transcatheter aortic valve replacement using valve academic research consortium definitions: a weighted meta-analysis of 3, 519 patients from 16 studies. J Am Coll Cardiol, 2012, 59(25): 2317-2326.
22. Wang J, Yu W, Jin Q, et al. Risk factors for post-TAVI bleeding according to the VARC-2 bleeding definition and effect of the bleeding on short-term mortality: a meta-analysis. Can J Cardiol, 2017, 33(4): 525-534.
23. 王昌进, 罗淞元, 李捷. 经导管主动脉瓣置换术入路及血管并发症的研究现状. 华西医学, 2021, 36(9): 1177-1183.
24. Beurtheret S, Karam N, Resseguier N, et al. Femoral versus nonfemoral peripheral access for transcatheter aortic valve replacement. J Am Coll Cardiol, 2019, 74(22): 2728-2739.
25. 孙英皓, 李捷, 郑胜能, 等. 经导管主动脉瓣置换术并发冠状动脉堵塞及腹膜后血肿一例. 华西医学, 2020, 35(9): 1131-1134.
26. Paradis JM, Altisent OA, RodÉs-Cabau J. Reducing periprocedural complications in transcatheter aortic valve replacement: review of paravalvular leaks, stroke, and vascular complications. Expert Rev Cardiovasc Ther, 2015, 13(11): 1251-1262.
27. 邢超凡, 潘欣, 何奔. 外科瓣膜置换术后瓣周漏相关性溶血的机制探讨及介入治疗进展. 中国介入心脏病学杂志, 2023, 31(2): 142-145.
28. Armijo G, Nombela-Franco L, Tirado-Conte G. Cerebrovascular events after transcatheter aortic valve implantation. Front Cardiovasc Med, 2018, 5: 104.
29. Tchetche D, Farah B, Misuraca L, et al. Cerebrovascular events post-transcatheter aortic valve replacement in a large cohort of patients: a FRANCE-2 registry substudy. JACC Cardiovasc Interv, 2014, 7(4): 1138-1145.
30. Kapadia SR, Kodali S, Makkar R, et al. Protection against cerebral embolism during transcatheter aortic valve replacement. J Am Coll Cardiol, 2017, 69(4): 367-377.
31. Fefer P, Bogdan A, Grossman Y, et al. Impact of rapid ventricular pacing on outcome after transcatheter aortic valve replacement. J Am Heart Assoc, 2018, 7(14): e009038.
32. Valtra W, Jimenez-Quevedo P, Tchétché D, et al. Predictors, incidence, and outcomes of patients undergoing transfemoral transcatheter aortic valve implantation complicated by stroke. Circ Cardiovasc Interv, 2019, 12(3): e007546.
33. 朱嘉俊, 赵倩, 李晓梅, 等. 经导管主动脉瓣置换术相关脑卒中及脑栓塞保护装置的研究现状. 华西医学, 2021, 36(9): 1161-1166.
34. 杨玉, 李榕彬, 刘春雪. 经导管主动脉瓣置换术患者二例的护理. 解放军护理杂志, 2012, 29(6): 37-39.
35. Zaleska-Kociecka M, Dabrowski M, Stepinska J. Acute kidney injury after transcatheter aortic valve replacement in the elderly: outcomes and risk management. Clin Interv Aging, 2019, 14: 195-201.
36. 张倩, 张文佳, 王墨扬, 等. 经导管主动脉瓣置换术后急性肾损伤的发生及危险因素的分析. 中国循环杂志, 2019, 34(11): 1079-1084.
37. Ram P, Mezue K, Pressman G, et al. Acute kidney injury post-transcatheter aortic valve replacement. Clin Cardiol, 2017, 40(12): 1357-1362.
38. Strauch JT, Scherner MP, Haldenwang PL, et al. Minimally invasive transapical aortic valve implantation and the risk of acute kidney injury. Ann Thorac Surg, 2010, 89(2): 465-470.
39. 张春, 蔡闵敏, 王海霞, 等. 经导管主动脉瓣膜置换术复杂高危患者围手术期护理管理策略. 中国继续医学教育, 2021, 13(9): 182-185.

West China Medical Journal

Progress in the care of complications after transcatheter aortic valve replacement

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