INVASIVE INTERVENTIONS IN STRUCTURAL HEART DISEASES: COMPREHENSIVE TECHNIQUES

Invasive Interventions in Structural Heart Diseases-kapak

TRANSFEMORAL AORTIC VALVE IMPLANTATION COMPLICATIONS AND MANAGEMENT

Hafize Corut Güzel

Bilkent City Hospital, Department of Cardiology, Ankara, Türkiye

Corut Güzel H. Transfemoral Aortic Valve Implantation Complications and Management. In: Tanık VO, Özlek B, editors. Invasive Interventions in Structural Heart Diseases: Comprehensive Techniques. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.243-258.

ABSTRACT

Transcatheter aortic valve implantation (TAVI) has emerged as a revolutionary treatment option for patients with symptomatic severe aortic stenosis who are at high risk for conventional surgical aortic valve replacement (SAVR). Initially considered a last resort for inoperable or high-risk individuals, TAVI has evolved into a widely adopted therapy, thanks to rapid advancements in TAVI technology and growing clinical experience. Transfemoral access, in particular, has become the preferred approach due to its association with a 20% relative reduction in mortality compared to SAVR. Despite these advancements in device technology and procedural techniques, TAVI is not without its challenges. Paravalvular leak (PVL), annular rupture, coronary artery obstruction, valve migration/embolization, atrioventricular (AV) conduction disturbances, vascular complications, and stroke remain significant concerns associated with TAVI, demanding careful attention as the procedure’s utilization expands. Early recognition and effective management of these complications are crucial for optimizing patient outcomes. This book chapter will delve into the significant complications associated with transfemoral TAVI and provide a comprehensive overview of their management strategies. Moreover, this chapter aims to equip cardiologists, cardiac surgeons, anesthesiologists, and other healthcare professionals involved in TAVI with the knowledge necessary to navigate the potential risks of this procedure and contribute to its successful execution. This chapter thoroughly examines vascular, valve-related, and arrhythmic complications, followed by a discussion of Coronary Occlusion, stroke complications, and their management.

Keywords: Transcatheter aortic valve implantation (TAVI); Valve replacement; Vascular complications; Arrhythmic complications; Coronary occlusion; Stroke

Referanslar

  1. Genereux P, Head SJ, Van Mieghem NM, Kodali S, Kirtane AJ, Xu K, et al. Clinical outcomes after transcatheter aortic valve replacement using valve academic research consortium definitions: a weighted meta-analysis of 3,519 patients from 16 studies. J Am Coll Cardiol. 2012;59(25):2317-26. [Crossref]  [PubMed]
  2. Genereux P, Webb JG, Svensson LG, Kodali SK, Satler LF, Fearon WF, et al. Vascular complications after transcatheter aortic valve replacement: insights from the PARTNER (Placement of AoRTic TraNscathetER Valve) trial. J Am Coll Cardiol. 2012;60(12):1043-52. [Crossref]  [PubMed]
  3. Kappetein AP, Head SJ, Genereux P, Piazza N, van Mieghem NM, Blackstone EH, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Thorac Cardiovasc Surg. 2013;145(1):6-23. [Crossref]  [PubMed]
  4. Van Mieghem NM, Tchetche D, Chieffo A, Dumonteil N, Messika-Zeitoun D, van der Boon RM, et al. Incidence, predictors, and implications of access site complications with transfemoral transcatheter aortic valve implantation. Am J Cardiol. 2012;110(9):1361-7. [Crossref]  [PubMed]
  5. Kappetein AP, Head SJ, Généreux P, Piazza N, van Mieghem NM, Blackstone EH, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. Eur Heart J. 2012;33(19):2403-18. [Crossref]  [PubMed]
  6. Van Mieghem NM, Nuis RJ, Piazza N, Apostolos T, Ligthart J, Schultz C, et al. Vascular complications with transcatheter aortic valve implantation using the 18 Fr Medtronic CoreValve System: the Rotterdam experience. EuroIntervention. 2010;5(6):673-9. [Crossref]  [PubMed]
  7. Dencker D, Pedersen F, Engstrøm T, Køber L, Højberg S, Nielsen MB, et al. Major femoral vascular access complications after coronary diagnostic and interventional procedures: A Danish register study. Int J Cardiol. 2016;202:604-8. [Crossref]  [PubMed]
  8. Tonnessen BH. Iatrogenic injury from vascular access and endovascular procedures. Perspect Vasc Surg Endovasc Ther. 2011;23(2):128-35. [Crossref]  [PubMed]
  9. Stone PA, Campbell JE, AbuRahma AF. Femoral pseudoaneurysms after percutaneous access. J Vasc Surg. 2014;60(5):1359-66. [Crossref]  [PubMed]
  10. Jud P, Eibisberger M. Pseudoaneurysm Following Transfemoral Percutaneous Aortic Valve Replacement. Dtsch Arztebl Int. 2021;118(4):58. [Crossref]
  11. Ott I, Shivaraju A, Schäffer NR, Frangieh AH, Michel J, Husser O, et al. Parallel suture technique with ProGlide: a novel method for management of vascular access during transcatheter aortic valve implantation (TAVI). EuroIntervention. 2017;13(8):928-34. [Crossref]  [PubMed]
  12. Chung TL, Mukherjee D. Successful endovascular management of an aortic rupture following stent placement for severe atherosclerotic stenosis: A case report. Int J Angiol. 2007;16(2):73-6. [Crossref]  [PubMed]  [PMC]
  13. Thomas M, Schymik G, Walther T, Himbert D, Lefèvre T, Treede H, et al. Thirty-day results of the SAPIEN aortic Bioprosthesis European Outcome (SOURCE) Registry: A European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve. Circulation. 2010;122(1):62-9. [Crossref]  [PubMed]
  14. Généreux P, Head SJ, Hahn R, Daneault B, Kodali S, Williams MR, et al. Paravalvular leak after transcatheter aortic valve replacement: the new Achilles' heel? A comprehensive review of the literature. J Am Coll Cardiol. 2013;61(11):1125-36. [Crossref]  [PubMed]
  15. Frick M, Meyer CG, Kirschfink A, Altiok E, Lehrke M, Brehmer K, et al. Evaluation of aortic regurgitation after transcatheter aortic valve implantation: aortic root angiography in comparison to cardiac magnetic resonance. EuroIntervention. 2016;11(12):1419-27. [Crossref]  [PubMed]
  16. Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012;366(18):1686-95. [Crossref]  [PubMed]
  17. Ando T, Holmes AA, Taub CC, Slovut DP, DeRose JJ. Iatrogenic Ventricular Septal Defect Following Transcatheter Aortic Valve Replacement: A Systematic Review. Heart Lung Circ. 2016;25(10):968-74. [Crossref]  [PubMed]
  18. Ohlow MA, Schreiber M, Lauer B. Percutaneous closure of an iatrogenic ventricular septal defect following transcatheter aortic valve implantation. J Cardiol Cases. 2017;16(5):165-7. [Crossref]  [PubMed]  [PMC]
  19. Dursun H, Erdal C, Ergene O, Unal B, Tanriverdi Z, Kaya D. Treatment of an unusual complication of transfemoral TAVI with a new technique: successful occlusion of ventricular septal defect by opening the closure device in the ascending aorta. Cardiovasc J Afr. 2015;26(1):e8-10. [Crossref]  [PubMed]
  20. Hayashida K, Lefèvre T, Chevalier B, Hovasse T, Romano M, Garot P, et al. Transfemoral aortic valve implantation new criteria to predict vascular complications. JACC Cardiovasc Interv. 2011;4(8):851-8. [Crossref]  [PubMed]
  21. Mach M, Okutucu S, Kerbel T, Arjomand A, Fatihoglu SG, Werner P, et al. Vascular Complications in TAVR: Incidence, Clinical Impact, and Management. J Clin Med. 2021;10(21) [Crossref]  [PubMed]  [PMC]
  22. Pibarot P, Hahn RT, Weissman NJ, Monaghan MJ. Assessment of paravalvular regurgitation following TAVR: a proposal of unifying grading scheme. JACC Cardiovasc Imaging. 2015;8(3):340-60. [Crossref]  [PubMed]
  23. Kodali S, Pibarot P, Douglas PS, Williams M, Xu K, Thourani V, et al. Paravalvular regurgitation after transcatheter aortic valve replacement with the Edwards sapien valve in the PARTNER trial: characterizing patients and impact on outcomes. Eur Heart J. 2015;36(7):449-56. [Crossref]  [PubMed]
  24. Gilard M, Eltchaninoff H, Iung B, Donzeau-Gouge P, Chevreul K, Fajadet J, et al. Registry of transcatheter aortic-valve implantation in high-risk patients. N Engl J Med. 2012;366(18):1705-15. [Crossref]  [PubMed]
  25. Dworakowski R, Wendler O, Halliday B, Ludman P, DeBelder M, Ray S, et al. Device-dependent association between paravalvar aortic regurgitation and outcome after TAVI. Heart. 2014;100(24):1939-45. [Crossref]  [PubMed]
  26. Forrest JK, Kaple RK, Tang GHL, Yakubov SJ, Nazif TM, Williams MR, et al. Three Generations of Self-Expanding Transcatheter Aortic Valves: A Report From the STS/ACC TVT Registry. JACC Cardiovasc Interv. 2020;13(2):170-9. [Crossref]  [PubMed]
  27. Sá MP, Van den Eynde J, Malin JH, Torregrossa G, Sicouri S, Ramlawi B. Impact of left ventricle outflow tract calcification on the outcomes of transcatheter aortic valve implantation: A study-level meta-analysis. J Card Surg. 2022;37(5):1379-90. [Crossref]  [PubMed]
  28. Reddy G, Wang Z, Nishimura RA, Greason KL, Yoon SH, Makkar RR, et al. Transcatheter aortic valve replacement for stenotic bicuspid aortic valves: Systematic review and meta analyses of observational studies. Catheter Cardiovasc Interv. 2018;91(5):975-83. [Crossref]  [PubMed]
  29. Zou Q, Wei Z, Sun S. Complications in transcatheter aortic valve replacement: A comprehensive analysis and management strategies. Curr Probl Cardiol. 2024;49(5):102478. [Crossref]  [PubMed]
  30. Mahmoud-Elsayed H. Added value of three-dimensional transesophageal echocardiography in management of mitral paravalvular leaks. Echocardiography. 2020;37(6):954-64. [Crossref]  [PubMed]
  31. Bhushan S, Huang X, Li Y, He S, Mao L, Hong W, et al. Paravalvular Leak After Transcatheter Aortic Valve Implantation Its Incidence, Diagnosis, Clinical Implications, Prevention, Management, and Future Perspectives: A Review Article. Curr Probl Cardiol. 2022;47(10):100957. [Crossref]  [PubMed]
  32. Kleczyński P, Dziewierz A, Daniec M, Bagieński M, Rzeszutko Ł, Sorysz D, et al. Impact of post-dilatation on the reduction of paravalvular leak and mortality after transcatheter aortic valve implantation. Kardiol Pol. 2017;75(8):742-8. [Crossref]  [PubMed]
  33. Hovasse T, Tchétché D. [TAVR and bicuspid aortic valve]. Ann Cardiol Angeiol (Paris). 2019;68(6):450-2. [Crossref]  [PubMed]
  34. Al-Abcha A, Saleh Y, Boumegouas M, Prasad R, Herzallah K, Baloch ZQ, et al. Meta-Analysis of Valve-in-Valve Transcatheter Aortic Valve Implantation Versus Redo-surgical Aortic Valve Replacement in Failed Bioprosthetic Aortic Valve. Am J Cardiol. 2021;146:74-81. [Crossref]  [PubMed]
  35. Pasic M, Unbehaun A, Buz S, Drews T, Hetzer R. Annular rupture during transcatheter aortic valve replacement: classification, pathophysiology, diagnostics, treatment approaches, and prevention. JACC Cardiovasc Interv. 2015;8(1 Pt A):1-9. [Crossref]  [PubMed]
  36. de Heer LM, Budde RP, Mali WP, de Vos AM, van Herwerden LA, Kluin J. Aortic root dimension changes during systole and diastole: evaluation with ECG-gated multidetector row computed tomography. Int J Cardiovasc Imaging. 2011;27(8):1195-204. [Crossref]  [PubMed]  [PMC]
  37. Coughlan JJ, Kiernan T, Mylotte D, Arnous S. Annular Rupture During Transcatheter Aortic Valve Implantation: Predictors, Management and Outcomes. Interv Cardiol. 2018;13(3):140-4. [Crossref]  [PubMed]  [PMC]
  38. Watanabe Y, Hayashida K, Lefèvre T, Chevalier B, Hovasse T, Romano M, et al. Transcatheter aortic valve implantation in patients of small body size. Catheter Cardiovasc Interv. 2014;84(2):272-80. [Crossref]  [PubMed]
  39. Pasic M, Unbehaun A, Dreysse S, Buz S, Drews T, Kukucka M, et al. Rupture of the device landing zone during transcatheter aortic valve implantation: a life-threatening but treatable complication. Circ Cardiovasc Interv. 2012;5(3):424-32. [Crossref]  [PubMed]
  40. Aksoy O, Paixao AR, Marmagkiolis K, Mego D, Rollefson WA, Cilingiroglu M. Aortic annular rupture during TAVR: Mini review. Cardiovasc Revasc Med. 2016;17(3):199-201. [Crossref]  [PubMed]
  41. Zamorano JL, Badano LP, Bruce C, Chan KL, Gonçalves A, Hahn RT, et al. EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease. J Am Soc Echocardiogr. 2011;24(9):937-65. [Crossref]  [PubMed]
  42. Revilla Martínez MI, Gutiérrez García H, San Román Calvar JA. Interventricular septum rupture after transcatheter aortic valve implantation. Eur Heart J. 2012;33(2):190. [Crossref]  [PubMed]
  43. Hayashida K, Bouvier E, Lefèvre T, Hovasse T, Morice MC, Chevalier B, et al. Potential mechanism of annulus rupture during transcatheter aortic valve implantation. Catheter Cardiovasc Interv. 2013;82(5):E742-6. [Crossref]  [PubMed]
  44. Nkomo VT, Suri RM, Pislaru SV, Greason KL, Sinak LJ, Holmes DR, et al. Delayed transcatheter heart valve migration and failure. JACC Cardiovasc Imaging. 2014;7(9):960-2. [Crossref]  [PubMed]
  45. Holmes DR, Jr., Brennan JM, Rumsfeld JS, Dai D, O'Brien SM, Vemulapalli S, et al. Clinical outcomes at 1 year following transcatheter aortic valve replacement. Jama. 2015;313(10):1019-28. [Crossref]  [PubMed]
  46. Barbash IM, Bogdan A, Fefer P, Spiegelstein D, Raanani E, Beinart R, et al. How should I treat a left ventricular outflow tract-migrated balloon-expandable transcatheter heart valve? EuroIntervention. 2016;11(12):1442-5. [Crossref]  [PubMed]
  47. Aurigemma C, Trani C, D'Errigo P, Barbanti M, Biancari F, Tarantini G, et al. Impact of vascular complications after transcatheter aortic valve implantation. VASC-OBSERVANT II sub-study. Catheter Cardiovasc Interv. 2023;102(2):381-91. [Crossref]  [PubMed]
  48. Nicolino A, Vischi M, Moshiri S, Salsano A, Passerone G, Chiarella F, et al. Valve migration into the left ventricular outflow tract managed by coaxial double-valve alignment. JACC Cardiovasc Interv. 2014;7(7):822-4. [Crossref]  [PubMed]
  49. Tiroch K, Schleiting H, Karpettas N, Schmitz E, Vetter HO, Seyfarth M, et al. How should I treat dislocation of a TAVI SAPIEN prosthesis into the left ventricle? EuroIntervention. 2015;10(11):1370-2. [Crossref]  [PubMed]
  50. Mollmann H, Kim WK, Kempfert J, Walther T, Hamm C. Complications of transcatheter aortic valve implantation (TAVI): how to avoid and treat them. Heart. 2015;101(11):900-8. [Crossref]  [PubMed]
  51. Auffret V, Puri R, Urena M, Chamandi C, Rodriguez-Gabella T, Philippon F, et al. Conduction Disturbances After Transcatheter Aortic Valve Replacement: Current Status and Future Perspectives. Circulation. 2017;136(11):1049-69. [Crossref]  [PubMed]
  52. Mangieri A, Montalto C, Pagnesi M, Lanzillo G, Demir O, Testa L, et al. TAVI and Post Procedural Cardiac Conduction Abnormalities. Front Cardiovasc Med. 2018;5:85. [Crossref]  [PubMed]  [PMC]
  53. Poels TT, Engels EB, Kats S, Veenstra L, van Ommen V, Vernooy K, et al. Occurrence and Persistency of Conduction Disturbances during Transcatheter Aortic Valve Implantation. Medicina (Kaunas). 2021;57(7). [Crossref]  [PubMed]  [PMC]
  54. Badertscher P, Knecht S, Zeljkovic I, Sticherling C, de Asmundis C, Conte G, et al. Management of conduction disorders after transcatheter aortic valve implantation: results of the EHRA survey. Europace. 2022;24(7):1179-85. [Crossref]  [PubMed]
  55. van Rosendael PJ, Delgado V, Bax JJ. Pacemaker implantation rate after transcatheter aortic valve implantation with early and new-generation devices: a systematic review. Eur Heart J. 2018;39(21):2003-13. [Crossref]  [PubMed]
  56. Gaede L, Kim WK, Liebetrau C, Dorr O, Sperzel J, Blumenstein J, et al. Pacemaker implantation after TAVI: predictors of AV block persistence. Clin Res Cardiol. 2018;107(1):60-9. [Crossref]  [PubMed]
  57. Kooistra NHM, van Mourik MS, Rodriguez-Olivares R, Maass AH, Nijenhuis VJ, van der Werf R, et al. Late onset of new conduction disturbances requiring permanent pacemaker implantation following TAVI. Heart. 2020;106(16):1244-51. [Crossref]  [PubMed]
  58. Chamandi C, Barbanti M, Munoz-Garcia A, Latib A, Nombela-Franco L, Gutierrez-Ibanez E, et al. Long-Term Outcomes in Patients With New-Onset Persistent Left Bundle Branch Block Following TAVR. JACC Cardiovasc Interv. 2019;12(12):1175-84. [Crossref]  [PubMed]
  59. Regueiro A, Abdul-Jawad Altisent O, Del Trigo M, Campelo-Parada F, Puri R, Urena M, et al. Impact of New-Onset Left Bundle Branch Block and Periprocedural Permanent Pacemaker Implantation on Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Circ Cardiovasc Interv. 2016;9(5):e003635. [Crossref]  [PubMed]
  60. Testa L, Latib A, De Marco F, De Carlo M, Agnifili M, Latini RA, et al. Clinical impact of persistent left bundle-branch block after transcatheter aortic valve implantation with CoreValve Revalving System. Circulation. 2013;127(12):1300-7. [Crossref]  [PubMed]
  61. Unzue L, Garcia E, Diaz-Anton B, Rodriguez-Rodrigo FJ, Rodriguez Del Rio M, Teijeiro R, et al. Left Bundle Branch Block after Transcatheter Aortic Valve Implantation with Edwards Sapien 3 Valve: Influence of the Valve Depth Implantation. Cardiovasc Revasc Med. 2019;20(11):949-55. [Crossref]  [PubMed]
  62. Lopez-Aguilera J, Segura Saint-Gerons JM, Mazuelos Bellido F, Suarez de Lezo Herreros de Tejada J, Pineda SO, Pan Alvarez-Ossorio M, et al. Effect of New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Implantation (CoreValve) on Mortality, Frequency of Re-Hospitalization, and Need for Pacemaker. Am J Cardiol. 2016;118(9):1380-5. [Crossref]  [PubMed]
  63. Halapas A, Koliastasis L, Doundoulakis I, Antoniou CK, Stefanadis C, Tsiachris D. Transcatheter Aortic Valve Implantation and Conduction Disturbances: Focus on Clinical Implications. J Cardiovasc Dev Dis. 2023;10(11) [Crossref]  [PubMed]  [PMC]
  64. Nazif TM, Chen S, George I, Dizon JM, Hahn RT, Crowley A, et al. New-onset left bundle branch block after transcatheter aortic valve replacement is associated with adverse long-term clinical outcomes in intermediate-risk patients: an analysis from the PARTNER II trial. Eur Heart J. 2019;40(27):2218-27. [Crossref]  [PubMed]
  65. Massoullie G, Ploux S, Souteyrand G, Mondoly P, Pereira B, Amabile N, et al. Incidence and management of atrioventricular conduction disorders in new-onset left bundle branch block after TAVI: A prospective multicenter study. Heart Rhythm. 2023;20(5):699-706. [Crossref]  [PubMed]
  66. Tsushima T, Main A, Al-Kindi SG, Dallan LAP, Wheat HL, Baeza CR, et al. Risk Stratification of New Persistent Left Bundle Branch Block After Transcatheter Aortic Valve Implantation. Am J Cardiol. 2022;175:80-7. [Crossref]  [PubMed]
  67. Sasaki K, Izumo M, Kuwata S, Ishibashi Y, Kamijima R, Watanabe M, et al. Clinical Impact of New-Onset Left Bundle-Branch Block After Transcatheter Aortic Valve Implantation in the Japanese Population- A Single High-Volume Center Experience. Circ J. 2020;84(6):1012-9. [Crossref]  [PubMed]
  68. Ribeiro HB, Nombela-Franco L, Urena M, Mok M, Pasian S, Doyle D, et al. Coronary obstruction following transcatheter aortic valve implantation: a systematic review. JACC Cardiovasc Interv. 2013;6(5):452-61. [Crossref]  [PubMed]
  69. Ribeiro HB, Webb JG, Makkar RR, Cohen MG, Kapadia SR, Kodali S, et al. Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry. J Am Coll Cardiol. 2013;62(17):1552-62. [Crossref]  [PubMed]
  70. Scarsini R, De Maria GL, Joseph J, Fan L, Cahill TJ, Kotronias RA, et al. Impact of Complications During Transfemoral Transcatheter Aortic Valve Replacement: How Can They Be Avoided and Managed? J Am Heart Assoc. 2019;8(18):e013801. [Crossref]  [PubMed]  [PMC]
  71. Felbel D, Buck C, Riedel N, Paukovitsch M, Stephan T, Krohn-Grimberghe M, et al. Combined Computed Coronary Tomography Angiography and Transcatheter Aortic Valve Implantation (TAVI) Planning Computed Tomography Reliably Detects Relevant Coronary Artery Disease Pre-TAVI. J Clin Med. 2024;13(16). [Crossref]  [PubMed]  [PMC]
  72. Tagliari AP, Petersen Saadi R, Medronha EF, Keller Saadi E. The Use of BASILICA Technique to Prevent Coronary Obstruction in a TAVI-TAVI Procedure. J Clin Med. 2021;10(23) [Crossref]  [PubMed]  [PMC]
  73. Zivelonghi C, Pesarini G, Scarsini R, Lunardi M, Piccoli A, Ferrero V, et al. Coronary Catheterization and Percutaneous Interventions After Transcatheter Aortic Valve Implantation. Am J Cardiol. 2017;120(4):625-31. [Crossref]  [PubMed]
  74. Kitamura M, Majunke N, Holzhey D, Desch S, Bani Hani A, Krieghoff C, et al. Systematic use of intentional leaflet laceration to prevent TAVI-induced coronary obstruction: feasibility and early clinical outcomes of the BASILICA technique. EuroIntervention. 2020;16(8):682-90. [Crossref]  [PubMed]
  75. Werner N, Zeymer U, Schneider S, Bauer T, Gerckens U, Linke A, et al. Incidence and Clinical Impact of Stroke Complicating Transcatheter Aortic Valve Implantation: Results From the German TAVI Registry. Catheter Cardiovasc Interv. 2016;88(4):644-53. [Crossref]  [PubMed]
  76. Kapadia SR, Kodali S, Makkar R, Mehran R, Lazar RM, Zivadinov R, et al. Protection Against Cerebral Embolism During Transcatheter Aortic Valve Replacement. J Am Coll Cardiol. 2017;69(4):367-77. [Crossref]  [PubMed]
  77. Nso N, Emmanuel K, Nassar M, Bhangal R, Enoru S, Iluyomade A, et al. Impact of new-onset versus pre-existing atrial fibrillation on outcomes after transcatheter aortic valve replacement/implantation. Int J Cardiol Heart Vasc. 2022;38:100910. [Crossref]  [PubMed]  [PMC]
  78. Suhai FI, Varga A, Szilveszter B, Nagy-Vecsey M, Apor A, Nagy AI, et al. Predictors and neurological consequences of periprocedural cerebrovascular events following transcatheter aortic valve implantation with self-expanding valves. Front Cardiovasc Med. 2022;9:951943. [Crossref]  [PubMed]  [PMC]
  79. Muralidharan A, Thiagarajan K, Van Ham R, Gleason TG, Mulukutla S, Schindler JT, et al. Meta-Analysis of Perioperative Stroke and Mortality in Transcatheter Aortic Valve Implantation. Am J Cardiol. 2016;118(7):1031-45. [Crossref]  [PubMed]
  80. Shrestha DB, Shtembari J, Lamichhane S, Baniya A, Shahi M, Dhungel S, et al. Safety and efficacy of cerebral embolic protection devices for patients undergoing transcatheter aortic valve replacement: An updated meta-analysis. Health Sci Rep. 2023;6(7):e1391. [Crossref]  [PubMed]  [PMC]
  81. Mohananey D, Sankaramangalam K, Kumar A, Jobanputra Y, Villablanca P, Krishnaswamy A, et al. Safety and efficacy of cerebral protection devices in transcatheter aortic valve replacement: A clinical end-points meta-analysis. Cardiovasc Revasc Med. 2018;19(7 Pt A):785-91. [Crossref]  [PubMed]
  82. Ciobanu AO, Gherasim L, Vinereanu D. Risk of Stroke After Transcatheter Aortic Valve Implantation: Epidemiology, Mechanism, and Management. Am J Ther. 2021;28(5):e560-e72. [Crossref]  [PubMed]