Impact of Complications During Transfemoral Transcatheter Aortic Valve Replacement: How Can They Be Avoided and Managed?

Abstract

T ranscatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis and is the treatment of choice for patients at prohibitive and high surgical risk. Extension of indications into intermediate surgical risk has begun, and recently 2 large randomized trials demonstrated that TAVR may be superior to surgery in patients at low surgical risk and can potentially offer better results at initial follow-up. TAVR practice has evolved continuously with concomitant simplification of the procedure. If one disregards the financial considerations, predictability of the procedural outcome and certainty regarding the durability of TAVR prostheses are 2 of the main remaining restrictions to universal implementation. Transfemoral access is the preferred approach, as it has a 20% relative reduction in mortality compared with surgical aortic valve replacement (SAVR) (hazard ratio HR, 0.80; 95% CI, 0.69–0.93; P=0.024). Understanding the mechanisms that underlie complications during transfemoral TAVR is essential, and familiarity with the techniques for their prevention and treatment is mandatory. In this review, we provide a state-ofthe-art overview on the avoidable procedural complications of contemporary transfemoral TAVR practice, with a specific focus on strategies for their prevention and management. Vascular Access Complications