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Brain & Heart TAVR in low gradient aortic stenosis

A B

C D

Figure 4. CT images demonstrating (A) HFU in the ascending aorta; (B) Calcium score on non-contrast CT; (C) AVA planimetry on contrast CT;
(D) Annular area on contrast CT. Image provided by the authors. Note: *The cutoff is 4 standard deviation + mean (319 HFU in this case)
Abbreviations: CT: Computed tomography; AVA: Aortic valve area.

6.1. Mechanical complications of bleeding and vascular complications. Vascular
Mechanical complications comprise a group of complications complications were reported in approximately 25% of the
that are exceedingly uncommon and are becoming participants in the PARTNER trial. The PARTNER trial
increasingly rare with the introduction of newer-generation revealed a four-fold increase in the 30-day mortality in
valves and increasing operator experience. Mechanical patients who experienced major bleeding complications,
35
complications include annular rupture, valve embolization, which is not observed in patients with minor bleeding.
ventricular perforation, iatrogenic ventricular septal defect, Hemostasis is attained following the removal of the sheath
intracardiac shunts, and coronary obstruction. Each of these using suture-mediated closure devices such as the Perclose
36
complications occur in <1% of TAVR procedures and mostly ProGlide or MANTA devices. A more comprehensive
37
necessitates urgent surgical conversion. Appropriate review of vascular bleeding is available elsewhere.
33
planning, sizing, and timing are essential to reduce the Although no randomized controlled trials have compared
likelihood of mechanical complications. There is evidence cLFLGAS and HG TAVR, observational studies have not
that cLFLGAS TAVR is associated with an increased need demonstrated a difference in bleeding rates to date. 38
for surgery; however, the reason for conversion to surgery
is uncertain. A more comprehensive review of mechanical 6.3. Stroke
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complications after TAVR can be located elsewhere. 33 Stroke continues to be a significant vulnerability in TAVR
procedures. The incidence of procedural or 30-day stroke
6.2. Vascular complications has not made significant strides since TAVR data tracking
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Accessing arteries and veins through large bore delivery began, with rates improving from 2.75% to 2.28%.
sheaths and manipulating catheters elevate the risk Patients with TAVR complicated with stroke have a 6-fold

Volume 3 Issue 1 (2025) 8 doi: 10.36922/bh.4017