Operative and Non-Operative Management of Aortic Injury during Balloon-Expandable TAVR

P0233 

Abstract Submission 

Shaelyn Cavanaugh (1), Hossein Amirjamshidi (1), Andrew Jones (1), Ariana Goodman (1), Kazuhiro Hisamoto (1)

(1) University of Rochester, Rochester, NY

Shaelyn Cavanaugh    -  Contact Me
University of Rochester

Hossein Amirjamshidi    -  Contact Me
University of Rochester

Andrew Jones    -  Contact Me
University of Rochester

Ariana Goodman    -  Contact Me
University of Rochester

Kazuhiro Hisamoto    -  Contact Me
University of Rochester

Shaelyn Cavanaugh    -  Contact Me
N/A

Objective: Transcatheter Aortic Valve Replacement (TAVR) has emerged as a safe and effective option for treatment of aortic valve disease in many patient populations. Although rare, aortic injury during TAVR can be devastating. Here, we present our center's experience with several cases of iatrogenic aortic complications that were successfully managed through both surgical and non-surgical intervention, all resulting in stabilization and ultimately hospital discharge.

Methods: We conducted a literature search to review the published literature on aortic complications of TAVR and retrospectively reviewed several patient electronic health records who underwent successful operative and non-operative management of a potentially devastating aortic complication of TAVR.

Results: Patient A suffered an annular rupture during pre-balloon dilation. Hemodynamic compromise suggested a complication which was then identified as annular rupture with pericardial effusion on an echocardiogram. After pericardiocentesis and stabilization of blood pressure, the patient was taken to the OR for successful surgical AVR with root repair. Patient B suffered an annular rupture during balloon-expansion of TAVR valve, resulting in effusion that was similarly identified on echocardiogram. After pericardiocentesis and injection of a hemostatic agent into the pericardial space, aortic root aortography demonstrated no further extravasation. The patient was observed closely with a temporary pericardial drain and discharged home with no further intervention. Patient C underwent TAVR that was complicated by a moderate paravalvular leak requiring post-balloon dilation. Shortly thereafter, an effusion was noted on echocardiogram. The patient underwent pericardiocentesis and pericardial drain placement, and surgical intervention was initially offered, however the patient's family declined intervention. The patient ultimately recovered from this and was discharged. Finally, Patient D suffered an acute ascending aortic dissection at the time of balloon expandable TAVR valve placement. Given that this procedure was performed under moderate sedation, neurologic deficits were able to be immediately identified by the heart team, prompting urgent imaging. The patient was then taken to the OR for successful hemiarch repair with antegrade and retrograde cerebral perfusion.

Conclusion: This case series emphasizes the importance of quick detection and effective management of aortic complications like dissection and annular rupture during TAVR. It highlights that prompt identification, coupled with a combination of surgical and non-surgical interventions can lead to successful patient outcomes. Finally, there are some proposed patient-related and procedural risk-factors for aortic injury during TAVR that are described in the literature, however further investigation is needed.

Aortic Surgery Forum (Basic Aortic Research, Venue for Residents, Fellows, Junior Attendings)