Fast Five Quiz: Aortic Stenosis

Yasmine S. Ali, MD

Disclosures

June 25, 2019

Recent studies have shown that select bicuspid anatomy is amenable to TAVR. TAVR is considered a reasonable alternative for patients with bicuspid aortic stenosis who are at intermediate or high risk for surgical aortic valve replacement. Although TAVR was initially only approved for high-risk and intermediate-risk patients, low-risk patients with bicuspid aortic stenosis may also now be preferentially treated using transcatheter techniques.

Contraindications to TAVR and exclusion criteria include the following:

  • Evidence of an acute myocardial infarction at 1 month (30 days) or less before the intended treatment

  • Mixed aortic valve disease

  • Hemodynamic or respiratory instability requiring inotropic support, mechanical ventilation, or mechanical heart assistance within 30 days of screening evaluation

  • Need for emergency surgery for any reason

  • Hypertrophic cardiomyopathy with or without obstruction

  • Severe left ventricular dysfunction with a left ventricular ejection fraction of < 20%

  • Severe pulmonary hypertension and right ventricular dysfunction

  • Echocardiographic evidence of intracardiac mass, thrombus, or vegetation

  • A known contraindication or hypersensitivity to all anticoagulation regimens or an inability to undergo anticoagulation for the study procedure

  • Native aortic annulus < 18 mm or > 25 mm, as measured with echocardiography

  • MRI-confirmed stroke or transient ischemic attack within 6 months (180 days) of the procedure

  • Renal insufficiency (creatinine level >3 mg/dL) and/or end-stage renal disease requiring chronic dialysis at the time of screening

  • Estimated life expectancy of < 12 months (365 days) because of noncardiac comorbid conditions

  • Severe incapacitating dementia

  • Significant aortic disease

  • Severe mitral regurgitation 

Vascular complications include aortic or iliofemoral dissection, vascular perforation, vessel rupture or avulsion, bleeding requiring significant blood transfusions, or additional percutaneous or surgical interventions. These are the most frequent adverse outcomes of TAVR and are especially common with the transfemoral approach. Ventricular perforation is a rare complication of transfemoral TAVR. Its management includes pericardial drainage and autotransfusion or conversion to open closure.

Read more on TAVR.

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