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TAVI Postprocedural Management

  • Piera Capranzano
  • Corrado Tamburino
Chapter

Abstract

Despite recent progresses in technology and operator experience and high procedural success rates, the transcatheter aortic valve implantation (TAVR) is associated with a non-negligible risk of thrombotic events, especially ischemic stroke. This risk of stroke is particularly high in the periprocedural period, but it steadily maintains during follow-up [1, 2]. Multiple factors can contribute to stroke in TAVR patients, including the following: introduction and manipulation of large valve systems in calcified arteries; exposition of tissue factor or arterial embolization of thrombogenic and inflammatory material subsequent to the important tissue injury caused by the positioning and implantation of the prosthesis valve when crushing the native valve; thrombi generated in areas of turbulent flow or blood stasis created by the new device overlying the native valve, especially in the case of small valve areas; tissue injury of the aortic wall triggering the thrombus formation; thromboembolism from bioprosthetic leaflets; peripheral vascular disease; and atrial fibrillation. This latter arrhythmia, in particular, is an important contributing factor, as it is present before the procedure in a relevant proportion (about 30%) of patients undergoing TAVR. In addition, it can develop newly after TAVR during follow-up in about 20% of patients who were on sinus rhythm at the time of the procedure [3]. Of importance, the advanced age and large burden of comorbidities typical of TAVR patients lead to a frequently high CHA2DS2-VASC score associated with a high annual risk of stroke.

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Cardiovascular DepartmentFerrarotto Hospital, University of CataniaCataniaItaly

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