Transcatheter Valve Treatment: Peri-procedural Management

  • Corrado Tamburino
  • Gian Paolo Ussia


Progress in the field of interventional cardiology today allows percutaneous treatment of various valve diseases. A growing population of elderly and/or high-risk patients can benefit from a non-surgical approach, with limited periprocedural risk and a minor incidence of adverse events compared to surgery. However, the severity of the clinical picture of these patients and the greater invasiveness and complexity of these procedures compared to conventional interventional cardiology procedures require a higher level of attention to detect and manage an ever growing number of “new” complications accompanying these innovative techniques. Therefore, all physicians involved in the management and care of these patients need to have adequate knowledge and be frequently updated on the pre- and post-procedural management, based on the experience gained day to day. This chapter illustrates various aspects relating to the diagnosis, management, and care of patients before and after novel aortic valve implantation procedures to treat aortic stenosis (AS) and mitral valve repair procedures using the Mitraclip® device to treat mitral regurgitation (MR). Special attention will be focused on the general and specific principles of each technique and the hemodynamic impairment model associated with each valve disease. Table 5.1 summarizes the components of routine care before and after transcatheter aortic valve implantation (TAVI) and Mitraclip® device implantation.


Mitral Regur Aortic Valve Replacement Pericardial Effusion Transcatheter Aortic Valve Implantation Thrombotic Thrombocytopenic Purpura 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Mehran R, Nikolsky E. Contrast induced nephropathy: definition, epidemiology and patients at risk. Kidney Int Suppl 2006;100: S11–15.CrossRefPubMedGoogle Scholar
  2. 2.
    Cockroff DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31–41.CrossRefGoogle Scholar
  3. 3.
    Mueller C, Buerkle G, Buettner HJ et al. Prevention of contrast media-associated nephropathy; randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med 2002;162:329–336.CrossRefPubMedGoogle Scholar
  4. 4.
    Briguori C, Colombo A, Violante A et al. Standard vs double dose of N-acetylcysteine to prevent contrast agent associated nephrotoxicity. Eur Heart J 2004;25:206–211.CrossRefPubMedGoogle Scholar
  5. 5.
    Birck R, Kzossok S, Markowetz F et al. Acetylcysteine for prevention of contrast nephropathy: meta-analysis. Lancet 2003;362:598–603.CrossRefPubMedGoogle Scholar
  6. 6.
    Grube E, Laborde JC, Gerckens U et al. Percutaneous implantation of the CoreValve selfexpanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study. Circulation 2006;114:1616–1624.CrossRefPubMedGoogle Scholar
  7. 7.
    Bennett CL, Kim B, Zakarija A et al. Two mechanistic pathways for thienopyridine-associated thrombotic thrombocytopenic purpura: a report from the SERF-TTP research group and the RADAR project. J Am Coll Cardiol 2007;50:1138–1143.CrossRefPubMedGoogle Scholar
  8. 8.
    Shantsila E, Lip GYH and Chong BH. Heparin-induced thrombocytopenia. Chest 2009;135:1651–1664.CrossRefPubMedGoogle Scholar
  9. 9.
    Webb JG, Pasupati S, Humphries K et al. Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis. Circulation 2007;116:755–763.CrossRefPubMedGoogle Scholar
  10. 10.
    Schaub F, Theiss W, Busch R et al. Management of 219 consecutive cases of postcatheterization pseudoaneurysm. J Am Coll Cardiol 1997;30:670–675.CrossRefPubMedGoogle Scholar
  11. 11.
    Bagai J, Zhao D. Subcutaneous “figure-of-eight” stitch to achieve hemostasis after removal of large-caliber femoral venous sheaths. Cardiac Interventions Today 2008;July/August:22–23.Google Scholar
  12. 12.
    NHLBI balloon valvuloplasty registry participants. Percutaneous balloon aortic valvuloplasty. Acute and 30-day follow-up results in 674 patients from the NHLBI balloon valvuloplasty registry. Circulation 1991;84:2383–2397.Google Scholar
  13. 13.
    Otto CM, Mickel MC, Kennedy JW et al. Three-year outcome after balloon aortic valvuloplasty. Insights into prognosis of valvular aortic stenosis. Circulation 1994;89:642–650.Google Scholar
  14. 14.
    Piazza N, Onuma Y, Jesserun E et al. Early and persistent intraventricular conduction abnormalities and requirements for pacemaking after percutaneous replacement of the aortic valve. JACC Cardiovasc Interv 2008;1:310–316.CrossRefPubMedGoogle Scholar
  15. 15.
    Sinhal A, Altwegg L, Pasupati S et al. Atrioventricular block after transcatheter balloon expandable aortic valve implantation. JACC Cardiovasc Interv 2008;1:305–309.CrossRefPubMedGoogle Scholar
  16. 16.
    Limongelli G, Ducceschi V, D’Andrea A et al. Risk factors for pacemaker implantation following aortic valve replacement: a single centre experience Heart 2003;89:901–904.CrossRefPubMedGoogle Scholar
  17. 17.
    Koplan BA, Stevenson WG, Epstein LM et al. Development and validation of a simple risk score to predict the need for permanent pacing after cardiac valve surgery. J Am Coll Cardiol 2003;41:795–801.CrossRefPubMedGoogle Scholar
  18. 18.
    Calvi V, Puzzangara E, Pruiti GP et al. Early conduction disorders following percutaneous aortic valve replacement. Pacing Clin Electrophysiol 2009;32:S126–130.CrossRefPubMedGoogle Scholar
  19. 19.
    Jilaihawi H, Chin D, Vasa-Nicotera M et al. Predictors for permanent pacemaker requirement after transcatheter aortic valve implantation with the CoreValve bioprosthesis. Am Heart J 2009;157:860–866.CrossRefPubMedGoogle Scholar
  20. 20.
    De Jaegere PP, Piazza N, Galema TW et al. Early echocardiographic evaluation following percutaneous implantation with the self-expanding CoreValve revalving system aortic valve bioprosthesis. EuroIntervention. 2008;4:351–357.PubMedGoogle Scholar
  21. 21.
    Piazza N, Schultz C, De Jaegere PP, Serruys P. Implantation of two self-expanding aortic bioprosthetic valves during the same procedure—insights into valve in-valve implantation (“Russian doll concept”). Catheter Cardiovasc Interv 2009;73:530–539.CrossRefPubMedGoogle Scholar
  22. 22.
    Bonow RO, Carabello BA, Chaterjee K et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of patients with valvular heart disease). J Am Coll Cardiol 2006;48:e1–148.CrossRefPubMedGoogle Scholar
  23. 23.
    Zoghbi WA, Enriquez-Sarano M, Foster E et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003;16:777–802.CrossRefPubMedGoogle Scholar
  24. 24.
    Foster E, Wasserman HS, Gray W et al. Quantitative assessment of severity of mitral regurgitation by serial echocardiography in a multicenter clinical trial of percutaneous mitral valve repair. Am J Cardiol 2007;100:1577–1583.CrossRefPubMedGoogle Scholar
  25. 25.
    Feldman T, Kar S, Rinaldi M et al: for the EVEREST Investigators. Percutaneous mitral repair with the MitraClip system: safety and midterm durability in the initial EVEREST (endovascular valve edge-to-edge repair study) cohort. J Am Coll Cardiol 2009;54;686–694.CrossRefPubMedGoogle Scholar
  26. 26.
    Butchart EG, Gohlke-Bärwolf C, Antunes MJ et al; Working Groups on Valvular Heart Disease, Thrombosis, Cardiac Rehabilitation, Exercise Physiology and European Society of Cardiology. Recommendations for the management of patients after heart valve surgery. Eur Heart J 2005;26:2463–2471.CrossRefPubMedGoogle Scholar
  27. 27.
    Vahanian A, Baumgartner H, Bax J et al. Guidelines on the management of valvular heart disease: The Task Force on the management of valvular heart disease of the European Society of Cardiology. Eur Heart J 2007;28:230–268.PubMedGoogle Scholar
  28. 28.
    Montorsi P, De Bernardi F, Muratori M et al. Role of cinefluoroscopy, transthoracic and TEE in patients with suspected prosthetic valve thrombosis. Am J Cardiol 2000;85: 58–64.CrossRefPubMedGoogle Scholar
  29. 29.
    Webb JG, Altwegg L, Boone RH et al. Transcatheter aortic valve implantation: impact on clinical and valve-related outcomes. Circulation 2009; 119:3009–3016.CrossRefPubMedGoogle Scholar
  30. 30.
    Comoglio C, Boffini M, El Quarra S et al. Aortic valve replacement and mitral valve repair as treatment of complications after percutaneous CoreValve implantation. J Thorac Cardiovasc Surg 2009;38:1025–1027.CrossRefGoogle Scholar
  31. 31.
    Maroto LC, Rodriguez JE, Cobiella J, Silva J. Delayed dislocation of a transapically implanted aortic bioprosthesis. Eur J Cardiothorac Surg 2009:36:935–937.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2010

Authors and Affiliations

  • Corrado Tamburino
    • 1
  • Gian Paolo Ussia
    • 2
  1. 1.Ferrarotto HospitalUniversity of Catania, ETNA FoundationCataniaItaly
  2. 2.Cardiology DivisionFerrarotto HospitalCataniaItaly

Personalised recommendations