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OBJECTIVE: TAVI (transcatheter aortic valve implantation) is becoming a routine procedure to treat severe symptomatic aortic stenosis. It is associatd with complications seen in conventional aortic valve replacement, like conduction disturbances, paravalvular leak, cerebral stroke, vascular events, ventricular perforation and coronary obstruction. However, false aneurysm of the left ventricle following a transapical TAVI is a more specific related complication to this procedure.
We report two patients with asymptomatic apical pseudoaneurysms at three months follow up.
METHODS: MSCT ECG gated scan was performed to demonstrate the defect in the apex, further proceded in the OsiriX sorftware to get a 3D reconstruction of the pseudoaneurysm. Differnt treatment options were considered, either a) conserrvative observation b) closure with a vascular plug or c) surgical intervention through a left mini thoracotomy. In the first patient the neck of the pseudoaneurysm was too wide to provide a vascular plug, in the second patient a plug could probably been used.
The first patient had peripheral atherosclerosis, so the cannulation was done through a small hemisternotomi for the aorta and a percutaneous cannula in the right femoral vein.
The second patient had a fem-fem partial bypass cannulation via cutdown in the groin. Both patients underwent a left mini thoracotomy and direct plication of the aneurysm with pledget reinforced everted mattress sutures on beating heart
RESULTS: Both patients had uneventful postoperative course. The first postoperative echo revealed no residual aneurysm. On echo follow-up echo at three months a small residual pseudoaneurysm was seen in the first patient.
CONCLUSIONS: Apical pseudoaneurysm may occur following transapical TAVI. It has to be established as a recognised complication to transapical TAVI when larger introducer systems > 30Fr are beeing used. Surgical recoonstruction should be done. Closure with vascular plugs may be an option for those with narrow neck.