Complications of percutaneous aortic valve replacement
Conventional aortic valve replacement (AVR) can be performed in good surgical candidates with an expectation of an excellent outcome. However, surgery in patients with comorbidities may be associated with significant morbidity and mortality. In some such patients percutaneous AVR may offer durable benefit while avoiding many of the problems associated with sternotomy, aortotomy, and cardiopulmonary bypass.1-3 However, a percutaneous procedure is associated with its own unique risks. Knowledge of the potential complications of percutaneous AVR is necessary both in the selection of appropriate candidates and in optimizing outcomes for this new therapeutic alternative. Percutaneous AVR is generally performed utilizing a
retrograde approach from the femoral artery. Two types of valves have seen extensive use: a balloon-expandable valve (Cribier Edwards™ or more recently the Edwards SAPIEN™ valve, Edwards Lifesciences, Inc) and a selfexpanding valve (CoreValve™, CoreValve, Inc). While there are many differences between these valves and procedures there are even more commonalities, particularly in terms of the potential risks (Table 35.1). An understanding of the nature of these potential complications, their avoidance, and mitigation is the subject of this chapter.