Author + information
- Ignacio Amat-Santos1,
- Pieter Stella2,
- Luis Nombela-Franco3,
- Roman Lezaun4,
- Antonio Munoz-Garcia5,
- Vicente Serra6,
- Enrique Gutiérrez7,
- Ramon Rodríguez-Olivares8,
- Silvio Vera9,
- Pablo Catala10 and
- Itziar Gomez11
- 1Institute of heart sciences (ICICOR) - Hospital Clínico Universitario, Valladolid, Spain
- 2University Medical Center Utrecht, Utrecht, Netherlands
- 3Hospital Clinico San Carlos, Madrid, Spain
- 4Hospital de Navarra, Pamplona, Spain
- 5Hospital Universitario Clinico Virgen de la Victoria, Malaga, Spain
- 6H. Vall d'Hebron, sant cugat del valles, Spain
- 7Hospital Universitario Gregorio Marañón, Madrid, Madrid, Spain
- 8Ramón y Cajal University Hospital, Madrid, Spain
- 9Institute of Heart Sciences - Hospital Clínico Universitario, Valladolid, Spain
- 10Institute of Heart Science - Hospital Clínico Universitario, Valladolid, Spain
- 11Institute of Heart Sciences, Valladolid, Spain
Intracardiac shunts (ICS) following transcatheter aortic valve implantation (TAVI) are an uncommon and barely described complication.
To describe the incidence, mechanisms, management and outcomes of ICS.
Multicentre registry across 10 centres aimed to gather all cases of ICS, compare features, management and outcomes according to aetiology (infection related –IRICS– or aseptic –AICS–), and search for predictors.
Patients who complicated with ICS (1.1%) within the first year post-TAVI presented porcelain aorta (24% vs 6.8%, p=0.024) and had been treated with predilation (88% vs 68.5%, p=0.037) or postdilation (59.1% vs 19.3%, p<0.001) more often. The median time from the intervention to the diagnosis of ICS was 10 days [IQR: 2-108], being longer for IRICS (171 [63-249]) than AICS (3 [1-12] days, p=0.002). Interventricular septum (55.6%) and anterior mitral leaflet (57.2%) were the most common locations in patients with AICS and IRICS, respectively. Locations of the shunts is schematically depicted in the Figure. Most patients (76%) developed heart failure and a majority were medically managed (55.6% AICS, 85.7% IRICS) whereas 7 patients (38.9%) with aseptic shunts underwent percutaneous closure. In-hospital mortality rate was 44% (IRICS 100%, AICS 27.8%) and was significantly higher than in global TAVI recipients (141 patients, 8.1%, p<0.001). At 1-year of follow-up 76% of the patients had died.
In conclusion, ICS following TAVI are an uncommon complication with 3/4 due to mechanical compression of calcium and 1/4 related to infective endocarditis. Mortality was >50% at 1-year of follow up and the prognosis was especially poor for those patients who presented infection or symptoms of heart failure. Medical treatment in symptomatic patients was associated to very high mortality whereas percutaneous closure of AICS was feasible but needs to be further investigated to determine if earlier attempts or specific devices may improve outcomes.
STRUCTURAL: Valvular Disease: Aortic