Pathology of transcatheter valve therapy.

TitlePathology of transcatheter valve therapy.
Publication TypeJournal Article
Year of Publication2012
AuthorsNietlispach, F, Webb, JG, Ye, J, Cheung, A, Lichtenstein, SV, Carere, RG, Gurvitch, R, Thompson, CR, Ostry, AJ, Matzke, L, Allard, MF
JournalJACC Cardiovasc Interv
Volume5
Issue5
Pagination582-90
Date Published2012 May
ISSN1876-7605
KeywordsAged, Aged, 80 and over, Amyloidosis, Aortic Valve, Aortic Valve Stenosis, Autopsy, British Columbia, Cardiac Catheterization, Cardiomyopathies, Cardiovascular Diseases, Cause of Death, Device Removal, Endocarditis, Female, Foreign-Body Migration, Heart Valve Prosthesis Implantation, Humans, Male, Middle Aged, Myocardium, Time Factors, Treatment Outcome
Abstract

OBJECTIVES: This study sought to report on the pathology of transcatheter aortic valves explanted at early and late time points after transcatheter aortic valve implantation.BACKGROUND: Information on pathological findings following transcatheter aortic valve implantation is scarce, particularly late after transcatheter aortic valve implantation.METHODS: This study included 20 patients (13 men, median age 80 years [interquartile range: 72 to 84] years) with previous transcatheter aortic valve implantation with a valve explanted at autopsy (n = 17) or surgery (n = 3) up to 30 months after implantation (10 transapical and 10 transfemoral procedures).RESULTS: Structural valve degeneration was not seen, although fibrous tissue ingrowth was observed at later time points with minimal effects on cusp mobility in 1 case. Minor alterations in valve configuration or placement were observed in up to 50% of cases, but they were not accompanied by substantial changes in valve function or reliably associated with chest compressions. Vascular or myocardial injury was common, especially within 30 days of transcatheter aortic valve implantation (about 69%), with the latter associated with left coronary ostial occlusion by calcified native aortic valve tissue in 2 cases. Mild to severe myocardial amyloidosis was present in nearly 33% of cases and likely played a role in the poor outcome of 3 patients. Endocarditis, migration of the valve, and embolization during the procedure led to surgical valve removal.CONCLUSIONS: Structural degeneration was not seen and minor alterations of valve configuration or placement did not affect valve function and were not reliably caused by chest compressions. Vascular or myocardial injury is very common early after transcatheter aortic valve implantation and myocardial amyloidosis represents a relatively frequent potentially significant comorbid condition.

DOI10.1016/j.jcin.2012.03.012
Alternate JournalJACC Cardiovasc Interv
PubMed ID22625199