Challenging Anatomy in Transcatheter Aortic Valve Implantation

Abstract

Several specific anatomical features have been associated with technical procedural complexity, increased risk of complications and impaired results after transcatheter aortic valve implantation (TAVI). The most frequent of these settings are bicuspid aortic valves, severe calcifications of the aortic complex (especially the left ventricle outflow tract), increased aortic angulation, low coronary arteries and challenging femoral access. In these conditions, correct deployment of the device (height, orientation and expansion) or even the simple advancement of the wires can be difficult or lead to serious complications. Indeed, higher degrees of paravalvular aortic regurgitation, asymmetric prosthesis deployment, conduction disturbances, coronary obstruction and tissue rupture can occur. Technological device improvements, careful preoperative planning through computed tomography, technical expertise and a Heart Team patient-tailored approach may allow to overcome most situations. Nevertheless, in the setting of younger lower-risk operable patients, severely unfavourable anatomy may prompt to reconsider a surgical approach, to provide each patient the safest, most effective, most durable treatment available.