• Samir R Kapadia, Lars G Svensson, Eric Roselli, Paul Schoenhagen, Zoran Popovic, Andrej Alfirevic, Benico Barzilai, Amar Krishnaswamy, William Stewart, Anand Mehta, Kanhaiya Lal Poddar, Akhil Parashar, Dhruv Modi, Alper Ozkan, Umesh Khot, Bruce W Lytle, and E Murat Tuzcu.
• Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
• Catheter Cardiovasc Interv. 2014 Nov 1;84(5):834-42.

BackgroundTranscatheter aortic valve replacement (TAVR) is an important treatment option for patients with severe symptomatic aortic stenosis (AS) who are inoperable or at high risk for complications with surgical aortic valve replacement. We report here our single-center data on consecutive patients undergoing transfemoral (TF) TAVR since the inception of our program, with a special focus on minimizing and managing complications.MethodsThe patient population consists of all consecutive patients who underwent an attempted TF-TAVR at our institution, beginning with the first proctored case in May 2006, through December 2012. Clinical, procedural, and echocardiographic data were collected by chart review and echo database query. All events are reported according to Valve Academic Research Consortium-2.ResultsDuring the study period, 255 patients with AS had attempted TF-TAVR. The procedure was successful in 244 (95.7%) patients. Serious complications including aortic annular rupture (n = 2), coronary occlusion (n = 2), iliac artery rupture (n = 1), and ventricular embolization (n = 1) were successfully managed. Death and stroke rate at 30 days was 0.4% and 1.6%, respectively. One-year follow-up was complete in 171 (76%) patients. One-year mortality was 17.5% with a 3.5% stroke rate. Descending aortic rupture, while advancing the valve, was the only fatal procedural event. There were 24.4% patients with ≥2+ aortic regurgitation.ConclusionsTAVR can be accomplished with excellent safety in a tertiary center with a well-developed infrastructure for the management of serious complications. The data presented here provide support for TAVR as an important treatment option, and results from randomized trials of patients with lower surgical risk are eagerly awaited.© 2014 The Authors. Catheterization and Cardiovascular Interventions. Published by Wiley Periodicals, Inc.

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