Acquired Ventricular Septal Defect Following Transcatheter Aortic Valve Replacement: A Systematic Review
Tomo Ando1, David Slovut2, Joseph DeRose2.
1Mount Sinai Beth Israel, New York, NY, USA, 2Montefiore Medical Center, Bronx, NY, USA.
Ventricular septal defect (VSD) has been rarely reported as a complication following transcatheter aortic valve replacement (TAVR). We sought to evaluate the baseline characteristics, management and outcomes of these patients.
Relevant studies were searched through PUBMED and EMBASE between 2002 to September 2015. The references were also manually reviewed for articles those included in the full article review. Congress abstracts were excluded. Articles that included baseline characteristics or hospital outcomes were included in the analysis.
A total of 16 studies including 18 patients were identified. The mean age was 83 ± 8, 38% were male and median Logistic EuroSCORE was 19.8 (range 11.7-33.8). There were 71% transfemoral approach. Pre-dilation was performed in 10 patients and post-dilation in 3. Self-expandable balloon was used in majority (89%) of the cases. The clinical presentation varied from asymptomatic to progressive heart failure. The timing of the diagnosis also varied significantly from immediately post valve implantation up to 1 year. There were 2 cases of Gerbode type defect while the rest were inter-ventricular defect. The location was mostly membranous or perimenbranous (94%), adjacent to the valve landing zone. Total of 7 interventions (1 open surgery and 6 percutaneous closure) were performed. The mortality rate was (17.6%). Those who survived had overall clinically stable course (range 12 days to 2 year).
Conclusions: The clinical course of reported cases of VSD following TAVR varied significantly from no symptoms to death. Self-expansion valve was implanted in majority of the cases and pre-dilation was performed in more than half of the cases. High clinical suspicion is needed when patient is deteriorating and no other obvious etiology is identified as the condition is often treatable with percutaneous approach.
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