Incidence and outcome of peri-procedural transcatheter heart valve embolization and migration: the TRAVEL registry (TranscatheteR HeArt Valve EmboLization and Migration).

Abstract

AIMS\nPeri-procedural transcatheter valve embolization and migration (TVEM) is a rare but potentially devastating complication of transcatheter aortic valve implantation (TAVI). We sought to assess the incidence, causes, and outcome of TVEM in a large multicentre cohort.\n\n\nMETHODS AND RESULTS\nWe recorded cases of peri-procedural TVEM in patients undergoing TAVI between January 2010 and December 2017 from 26 international sites. Peri-procedural TVEM occurred in 273/29\xa0636 (0.92%) TAVI cases (age 80.8\u2009±\u20097.3\u2009years; 53.8% female), of which 217 were to the ascending aorta and 56 to the left ventricle. The use of self-expanding or first-generation prostheses and presence of a bicuspid aortic valve were independent predictors of TVEM. Bail-out measures included repositioning attempts using snares or miscellaneous tools (41.0%), multiple valve implantations (83.2%), and conversion to surgery (19.0%). Using 1:4-propensity matching, we identified a cohort of 235 patients with TVEM (TVEMPS) and 932 patients without TVEM (non-TVEMPS). In the matched cohort, all-cause mortality was higher in TVEMPS than in non-TVEMPS at 30\u2009days (18.6% vs. 4.9%; P\u2009<\u20090.001) and after 1\u2009year (30.5% vs. 16.6%; P\u2009<\u20090.001). Major stroke was more frequent in TVEMPS at 30\u2009days (10.6% vs. 2.8%; P\u2009<\u20090.001), but not at 1\u2009year (4.6% vs. 1.9%; P\u2009=\u20090.17). The need for emergent cardiopulmonary support, major stroke at 30\u2009days, and acute kidney injury Stages 2 and 3 increased the risk of 1-year mortality, whereas a better renal function at baseline was protective.\n\n\nCONCLUSION\nTranscatheter valve embolization and migration occurred in approximately 1% and was associated with increased morbidity and mortality.