While going to the jungle in South Africa, the big time hunters were afraid of five most feared animals who were extremely dangerous if they encountered any of them while walking on foot. In a suggestive sense while we are going on hunting for treatment of severe aortic valve stenosis by transcatheter aortic valve replacement (TAVR) as a replacement technique to surgical aortic valve replacement (SAVR). There are five big complications which can be encountered while doing the TAVR procedure.
In the last few years TAVR has become the most popular procedure and in fact, is becoming standard of care for patients with severe aortic stenosis at increased surgical risk. Now it is possible to show that overall in-hospital mortality after transvascular TAVR was numerically lower than after SAVR and it is surprising that this betterment is seen even when patients for TAVR are at much higher surgical risk than SAVR. The risk associated with surgical revascularization is absolutely different than the risk associated with percutaneous intervention. Experience over the years has identified five big complications that directly impact survival after TAVR: moderate/severe paravalvular leakage (PVL); major vascular and bleeding complications; disabling stroke; acute kidney injury (AKI); and conduction abnormalities, such as a high-degree atrioventricular block.
If we are able to see the procedure being completed as an event-free procedure without an occurrence of any of these five complications, the TAVR has maximum benefits and lowest mortality and morbidity.
In a study published in the journal JACC: Cardiovascular Interventions, Arnold et al. studied the impact of these five periprocedural complications in patients from PARTNER 2 studies and found out that there is much substantial impact on mortality and quality of life on the patients treated with TAVR without these five complications. Therefore an event-free TAVR procedure, especially with these big five, can be the ultimate goal of procedural success and well being of the patients.