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Postprocedural management of patients after transcatheter aortic valve implantation procedure with self‐expanding bioprosthesis
Author(s) -
Ussia Gian Paolo,
Scarabelli Marilena,
Mulè Massimiliano,
Barbanti Marco,
Cammalleri Valeria,
Immè Sebastiano,
Aruta Patrizia,
Pistritto Anna Maria,
Carbonaro Alessandro,
Deste Wanda,
Sciuto Paolo,
Licciardello Giovanni,
Calvi Valeria,
Tamburino Corrado
Publication year - 2010
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.22602
Subject(s) - medicine , percutaneous , atrioventricular block , surgery , adverse effect , perforation , cardiology , intensive care unit , acute kidney injury , materials science , punching , metallurgy
Background : Transcatheter aortic valve implantation (TAVI) carries higher risk of post‐procedural adverse events than conventional percutaneous cardiovascular interventions. We report our experience about postoperative management protocol adopted in our Division. Methods : One hundred and ten patients underwent TAVI and 108 were transferred to the cardiac intensive care unit (CICU) after procedure. During the first 48 hours, vital parameters were monitored continuously. Close attention was given to rhythm and atrio‐ventricular conduction disturbances, systemic blood pressure, fluid balance and vascular accesses. Results : The most common complications were renal impairment (21.3%), femoral artery pseudo‐aneurysms (FAP) (11%), new complete atrioventricular block (20.3 %), cerebral vascular accident (4.5%) and cardiac perforation due to temporary pacemaker lead (1.8%). Ultrasound‐guided compression repair was considered the first line treatment for FAP, but in 6 cases surgical treatment was immediately performed due to the rapid expansion of FAP. Complete atrio‐ventricular block occurred in 22 patients (20.3 %) within the first 24 hours after TAVI and a permanent pacemaker was implanted in 21 patients (19.1%). Acute kidney injury occurred in 18 patients (35%) with pre‐procedural chronic renal failure and in 5 patients (9%) without preoperative renal dysfunction. Conclusions : After TAVI, cardiovascular complications are common and therefore accurate standardized management of patients in CICU during the first 48 hours is mandatory to early detect and manage complications and to decrease the rate of adverse events and the length of in‐hospital stay. © 2010 Wiley‐Liss, Inc.