Prevention and management of transcatheter balloon‐expandable aortic valve malposition

摘要: Objectives: Early clinical outcomes in selected high-risk patients undergoing catheter-based aortic valve replacement (AVR) compare favorably with conventional surgical AVR. Improved understanding of the mechanisms success and failure transcatheter AVR will likely improve further. To this end, we examined our experience during developmental phases describe causes management prosthetic malposition. Methods: Transcatheter balloon-expandable was performed 170 at two centers. Malposition defined as implantation a location other than within native valve. Patients were prospectively identified followed part an ongoing database. Results: Valve malposition occurred 9 (5.3%). Final position supravalvular eight nine cases. In all cases, embolization to ascending aorta few cardiac cycles following deployment. Importantly, late not observed. most prosthesis uneventfully repositioned more distal aorta. Positioning subvalvular one patient (0.6%), resulting severe regurgitation residual stenosis. Implantation second attempted six successful all. Conventional patients, early mortality one. At follow-up (mean 412 days), seven remain alive (78%) functioning relief stenosis. Conclusions: Malposition current valves is largely preventable complication. An improved procedure minimize possibility mitigate consequences should occur. © 2008 Wiley-Liss, Inc.