Postprocedural management of patients after transcatheter aortic valve implantation procedure with self-expanding bioprosthesis

Background: Transcatheter aortic valve implantation (TAVI) carries higher risk of postprocedural adverse events than conventional percutaneous cardiovascular interventions.We report our experience about postoperative management protocol adopted in our division.Methods: One hundred and ten patients underwent TAVI and 108 were transferred to the cardiac intensive care unit (CICU) after procedure. During the first 48 hours, vitalparameters were monitored continuously. Close attention was given to rhythm andatrio-ventricular conduction disturbances, systemic blood pressure, fluid balance andvascular accesses. Results: The most common complications were renal impairment (21.3%), femoral artery pseudo-neurysms (FAP) (11%), new complete atrioventricular block (20.3%), cerebral vascular accident (4.5%) and cardiac perforation due to temporarypacemaker lead (1.8%). Ultrasound-guided compression repair was considered thefirst line treatment for FAP, but in 6 cases surgical treatment was immediately performed due to the rapid expansion of FAP. Complete atrio-ventricular block occurred in 22 patients (20.3%) within the first 24 hours after TAVI and a permanent pacemaker wasimplanted in 21 patients (19.1%). Acute kidney injury occurred in 18 patients (35%) with pre-procedural chronic renal failure and in 5 atients (9%) without preoperative renal dysfunction. Conclusions: After TAVI, cardiovascular complications are common and therefore accurate standardized management of patients in CICU during the first 48 hours is mandatory to early detect and manage complications and to decrease the rate of adverse events and the length of in-hospital stay.