Overview
Aortic valve fibrosis, often manifesting as pannus formation, can lead to dysfunction of mechanical aortic valves, causing intermittent severe aortic regurgitation and hemodynamic instability 4. In the context of transcatheter aortic valve implantation (TAVI), aortic arch morphology and vascular access complications are significant factors influencing procedural outcomes and cerebrovascular accident risk 12.Diagnosis
Preprocedural Imaging: Assess aortic arch morphology using CT scans, noting arch angle, calcification, and soft plaques 1.
Vascular Access Site Evaluation: Detailed multislice CT analysis for vessel angulation and calcification at the puncture site 2.
Cerebral Protection System Deployment: Consider imaging guidance (e.g., CT-overlay) for complex aortic arch anatomy to minimize procedural risks 3.Management
Mechanical Valve Dysfunction Due to Pannus: Consider surgical intervention for severe, intermittent dysfunction unresponsive to medical management 4.
Vascular Complications: Monitor and manage vascular access site complications according to VARC-2 criteria, with attention to device-specific risks 2.
Cerebral Protection: Utilize cerebral protection systems judiciously, optimizing deployment techniques to reduce cerebral embolization risk 3.Special Populations
Elderly Patients: Higher prevalence of aortic arch calcification and soft plaques may increase CVA risk post-TAVI 1.
Comorbidities: Peripheral arterial disease and multiple valve implantations are significant predictors of adverse outcomes 1.Key Recommendations
Preprocedural Assessment of Aortic Arch Morphology: Evaluate aortic arch angle, calcification, and soft plaques via CT scans to predict CVA risk post-TAVI (Evidence: Moderate 1).
Use of Advanced Imaging for Complex Anatomy: Employ imaging techniques like CT-overlay to facilitate safe deployment of cerebral protection systems in patients with anomalous aortic arch anatomy (Evidence: Weak 3).
Close Monitoring of Vascular Access Site: Implement rigorous monitoring and management protocols for vascular complications, especially in patients with vessel angulation and calcification (Evidence: Moderate 2).References
1 Baltruskeviciute L, Moccetti F, Wolfrum M, Loretz L, Brunner S, Hakimi M et al.. Aortic Arch Morphology and Cerebrovascular Accidents After Transfemoral Transcatheter Aortic Valve Implantation. The American journal of cardiology 2026. link
2 Kmiec L, Zerdzitzki M, Schmid C, Debl K, Sossalla S, Hilker M et al.. Evaluation of the MANTA Vascular Closure Device in Transfemoral TAVI. The Thoracic and cardiovascular surgeon 2023. link
3 Mbai M, Sharma A, Oestreich B, Sievert K, Sobotka A, Schnelle N et al.. CT-Overlay Hybrid Imaging to Facilitate Sentinel Cerebral Protection System Deployment in the Presence of an Anomalous Vertebral Artery Originating From the Aortic Arch During Transcatheter Aortic Valve Implantation. Cardiovascular revascularization medicine : including molecular interventions 2021. link
4 Giroux SK, Labinaz MX, Grisoli D, Klug AP, Veinot JP, Burwash IG. Intermittent, noncyclic dysfunction of a mechanical aortic prosthesis by pannus formation. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 2010. link