P233. Operative and Non-Operative Management of Aortic Injury during Balloon-Expandable TAVR
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
University of Rochester Medical Center
Rochester, NY
United States - Contact Me
Shaelyn Cavanaugh is a General Surgery Resient at the University of Rochester who is interested in pursuing a career in Cardiothoracic Surgery.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
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.
Authors
Shaelyn Cavanaugh (1), Hossein Amirjamshidi (1), Andrew Jones (1), Ariana Goodman (1), Kazuhiro Hisamoto (1)
Institutions
(1) University of Rochester, Rochester, NY
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.
Authors
Shaelyn Cavanaugh (1), Hossein Amirjamshidi (1), Andrew Jones (1), Ariana Goodman (1), Kazuhiro Hisamoto (1)
Institutions
(1) University of Rochester, Rochester, NY
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.