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Transcatheter and Surgical Approaches to Complications of Transcatheter Procedures: Current...
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Transcatheter and Surgical Approaches to Complications of Transcatheter Procedures: Current Trends and Future Challenges

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Cardiac Surgery".

Deadline for manuscript submissions: 31 December 2025 | Viewed by 9596

Special Issue Editors

Dr. Antonio Nenna

E-Mail Website
Guest Editor
Unit of Cardiac Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
Interests: cardiac surgery; heart valve surgery; critical care
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Giuseppe Patti

E-Mail Website
Guest Editor
Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
Interests: cardiology; transcatheter procedures; TAVI
Dr. Giovanni Casali

E-Mail Website
Guest Editor
Unit of Cardiac Surgery, Ospedale Maggiore della Carità di Novara, Corso Mazzini 18, 28100 Novara, Italy
Interests: cardiac surgery; heart valve surgery; critical care

Special Issue Information

Dear Colleagues,

Over the last years, transcatheter procedures [such as transcatheter aortic valve implantation (TAVI), transcatheter mitral and tricuspid valve edge-to-edge repair (M-TEER and T-TEER), transcatheter mitral and tricuspid repair or replacement (TMVR and TTVR), transcatheter left atrial appendage occlusion (LAAO), transcatheter paravalvular leak (PVL) closure, and transcatheter closure of patent foramen ovale (PFO)] have become an important minimally invasive alternative to open-heart cardiac surgery for patients at high surgical risk and suffering from severe valve disease. Modern cardiac imaging, the computational tools for the 3D imaging analysis of cardiac and vascular structures, and the use of fusion technologies during procedures have become important key factors for the success of percutaneous procedures. Similarly, the evolution of devices has helped in improving the hemodynamic results, simplifying the procedural steps and lowering the rate of procedural unsuccess, vascular injury, paravalvular leak, and permanent pacemaker implantation.

However, adverse events still represent a daunting issue of transcatheter procedures, as both short term (e.g., valve mal-positioning) and long term (e.g., device endocarditis) complications damper the benefits of the procedure and might pose patients at extremely high risk for their urgent or emergent treatment. This Special Issue aims to summarize the latest advances in the treatment of transcatheter procedures related complications, focusing on both percutaneous and surgical approaches.

By reading this Special Issue, cardiologists and cardiac surgeons involved in modern heart teams should easily improve their knowledge by learning about the latest trends in transcatheter procedures as presented by experts in the field. Both original research contributions and state-of-the-art reviews are welcome.

Dr. Antonio Nenna
Prof. Dr. Giuseppe Patti
Dr. Giovanni Casali
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • transcatheter
  • complications
  • cardiac surgery
  • heart valve surgery
  • complications
  • TAVR

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Published Papers (7 papers)

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Research

Jump to: Review, Other

18 pages, 344 KB  
Article
Clinical Significance of TAPSE/PASP Ratio in Risk Stratification for Aortic Stenosis Patients Undergoing Transcatheter Aortic Valve Replacement
by Simina Mariana Moroz, Alina Gabriela Negru, Silvia Luca, Daniel Nișulescu, Mirela Baba, Darius Buriman, Ana Lascu, Daniel Florin Lighezan and Ioana Mozos
J. Cardiovasc. Dev. Dis. 2025, 12(12), 468; https://doi.org/10.3390/jcdd12120468 - 29 Nov 2025
Viewed by 210
Abstract
Aortic stenosis (AS), a progressive valvular disease that results in increasing left ventricular (LV) afterload, leads to ventricular dysfunction and heart failure if left untreated. Transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive and effective alternative to surgical replacement, especially [...] Read more.
Aortic stenosis (AS), a progressive valvular disease that results in increasing left ventricular (LV) afterload, leads to ventricular dysfunction and heart failure if left untreated. Transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive and effective alternative to surgical replacement, especially in elderly or high-risk patients. Objectives: The present study aims to assess the influence of the tricuspid annular plane systolic excursion (TAPSE)/pulmonary systolic arterial pressure (PASP) ratio on clinical outcomes in patients with aortic stenosis undergoing TAVR and offer valuable insights into patient selection and tailored management strategies for individuals undergoing TAVR. Methods: A retrospective analysis was conducted on 100 patients with AS who underwent TAVR, included in two distinct groups based on their median TAPSE/PASP ratio. Results: Patients were divided according to their median TAPSE/PASP ratio into two groups. Those with lower TAPSE/PASP ratios had a higher incidence of post-procedural atrial fibrillation (AF) (48% vs. 28%, p = 0.0404), lower left-ventricular ejection fraction (LVEF) (41.06% vs. 49.50%, p < 0.0001), a more pronounced inflammatory and hematologic response, and longer hospitalization. Receiver-operating characteristic (ROC) analysis demonstrated modest but significant discrimination rather than high sensitivity or specificity for postprocedural arrhythmias, particularly atrial fibrillation. Conclusions: TAPSE/PASP should be regarded as a clinically useful risk-stratification marker in patients with AS undergoing TAVR, enabling the identification of high-risk patients and optimizing peri-procedural management. Full article
(This article belongs to the Special Issue Transcatheter and Surgical Approaches to Complications of Transcatheter Procedures: Current Trends and Future Challenges)
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Review

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10 pages, 1803 KB  
Review
Left Ventricular Apical Cannulation in Acute Type A Aortic Dissection
by Benedetto Ferraresi, Antonio Nenna, Mohamad Jawabra, Diletta Corrado, Filippo Barberi, Carmelo Dominici, Giovanni Casali, Massimo Chello and Mario Lusini
J. Cardiovasc. Dev. Dis. 2025, 12(11), 451; https://doi.org/10.3390/jcdd12110451 - 19 Nov 2025
Viewed by 307
Abstract
Background and objectives: In cases of acute type A aortic dissection, including iatrogenic cases following transcatheter procedures, the choice of arterial cannulation site has a critical influence on early haemodynamics, organ protection and the risk of malperfusion. Transapical left ventricular cannulation has been [...] Read more.
Background and objectives: In cases of acute type A aortic dissection, including iatrogenic cases following transcatheter procedures, the choice of arterial cannulation site has a critical influence on early haemodynamics, organ protection and the risk of malperfusion. Transapical left ventricular cannulation has been suggested as a ‘central’ approach for rapidly establishing cardiopulmonary bypass with antegrade true-lumen flow. This review summarises the current evidence on TAC in acute type A dissection, focusing on indications, technical aspects and clinical outcomes. Materials and methods: We conducted a narrative review of observational studies and technical reports describing TAC for the surgical repair of acute type A aortic dissection. Particular attention was paid to patient selection, operative technique, perioperative complications, and early and mid-term results. Results: Across the published series, TAC is primarily employed in haemodynamically unstable patients or when the peripheral arteries are dissected, diseased, or unsuitable. A long arterial cannula is introduced through the left ventricular apex, crosses the aortic valve and is positioned in the true lumen of the ascending aorta under echocardiographic guidance. This configuration enables the rapid initiation of CPB, shortens skin-to-pump times, and provides reliable antegrade inflow. Early mortality and stroke rates are comparable to those associated with other cannulation strategies. Reported complications include malperfusion requiring site conversion, apical bleeding and rare local structural damage. These can be minimised through standardised technique and systematic imaging. Conclusions: TAC is a valuable bail-out option and, in selected patients, a primary cannulation option for acute type A aortic dissection when conventional arterial access is unsafe or ineffective. Although it offers fast and reproducible establishment of antegrade true-lumen flow, it requires specific expertise in apical exposure and intraoperative echocardiography. It should therefore be integrated into a structured perfusion and repair strategy. Full article
(This article belongs to the Special Issue Transcatheter and Surgical Approaches to Complications of Transcatheter Procedures: Current Trends and Future Challenges)
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13 pages, 643 KB  
Review
Antithrombotic Therapy in Transcatheter Aortic Valve Implantation: Focus on Gender Differences
by Mattia De Gregorio, Andrea Denegri, Filippo Luca Gurgoglione, Giorgio Benatti, Iacopo Tadonio, Emilia Solinas, Davide Carino, Andrea Agostinelli, Luigi Vignali and Giampaolo Niccoli
J. Cardiovasc. Dev. Dis. 2025, 12(11), 433; https://doi.org/10.3390/jcdd12110433 - 2 Nov 2025
Viewed by 782
Abstract
Antithrombotic therapy plays a pivotal role in reducing thromboembolic complications, including stroke and valve thrombosis, following Transcatheter Aortic Valve Implantation (TAVI). However, the benefits of such therapy must be balanced against the increased risk of major bleeding events. The optimal antithrombotic strategy in [...] Read more.
Antithrombotic therapy plays a pivotal role in reducing thromboembolic complications, including stroke and valve thrombosis, following Transcatheter Aortic Valve Implantation (TAVI). However, the benefits of such therapy must be balanced against the increased risk of major bleeding events. The optimal antithrombotic strategy in this setting remains a matter of ongoing debate, given the heterogeneity of patient profiles and procedural variables. Among TAVI recipients, women represent a growing proportion and exhibit distinct anatomical, physiological, and clinical characteristics that influence both thrombotic and bleeding risk. Compared to men, women more frequently experience vascular complications and major bleeding events, despite better survival outcomes. These differences are driven by smaller vessel caliber, higher vascular tortuosity, and altered platelet reactivity. Consequently, sex-specific risk stratification is essential when considering antiplatelet or anticoagulant regimens post-TAVI. This review provides a comprehensive synthesis of current evidence regarding antithrombotic strategies in the post-TAVI setting, with a dedicated focus on sex-related differences. Particular emphasis is placed on the female population, assessing ischemic and hemorrhagic outcomes and the implications for long-term management. Improving outcomes in women undergoing TAVI necessitates tailored antithrombotic strategies that balance efficacy and safety. Ongoing research and dedicated trials are essential to refine these strategies and to inform future guideline updates in this expanding patient population. Full article
(This article belongs to the Special Issue Transcatheter and Surgical Approaches to Complications of Transcatheter Procedures: Current Trends and Future Challenges)
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10 pages, 3407 KB  
Review
Management of TAVI Underexpansion with Self-Expanding Valves: A Practical Approach
by Rene Hameau, Marco B. Ancona, Vittorio Romano, Luca Ferri, Barbara Bellini, Filippo Russo, Ciro Vella, Christos Papageorgiu, Francesca Napoli, Marco Licciardi, Gianluca Ricchetti, Andrea Tripoli, Rocco Sabarese, Lorenzo Zaccaria and Matteo Montorfano
J. Cardiovasc. Dev. Dis. 2025, 12(6), 215; https://doi.org/10.3390/jcdd12060215 - 7 Jun 2025
Cited by 1 | Viewed by 1507
Abstract
Underexpansion of a self-expanding transcatheter aortic valve (TAVI) is a critical issue that can negatively impact long-term outcomes, including paravalvular leak, valve thrombosis, and increased mortality. This paper provides a comprehensive review of the pathophysiology and consequences of such complications, including three primary [...] Read more.
Underexpansion of a self-expanding transcatheter aortic valve (TAVI) is a critical issue that can negatively impact long-term outcomes, including paravalvular leak, valve thrombosis, and increased mortality. This paper provides a comprehensive review of the pathophysiology and consequences of such complications, including three primary mechanisms: (1) infolding, (2) incorrect site of crossing and (3) true underexpansion. It also discusses strategies to address these challenges, including pre-procedural planning and procedural techniques to ensure proper valve deployment and expansion. Mitigating these issues is essential to improving both immediate and long-term outcomes in TAVI patients. Full article
(This article belongs to the Special Issue Transcatheter and Surgical Approaches to Complications of Transcatheter Procedures: Current Trends and Future Challenges)
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20 pages, 1092 KB  
Review
Paravalvular Leak in Transcatheter Aortic Valve Implantation: A Review of Current Challenges and Future Directions
by Andreas Synetos, Nikolaos Ktenopoulos, Odysseas Katsaros, Konstantina Vlasopoulou, Maria Drakopoulou, Leonidas Koliastasis, Ioannis Kachrimanidis, Anastasios Apostolos, Sotirios Tsalamandris, George Latsios, Konstantinos Toutouzas, Ioannis Patrikios and Constantinos Tsioufis
J. Cardiovasc. Dev. Dis. 2025, 12(4), 125; https://doi.org/10.3390/jcdd12040125 - 31 Mar 2025
Cited by 4 | Viewed by 3197
Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as a revolutionary therapeutic modality for the management of severe aortic stenosis (AS), particularly in patients who are at high or prohibitive risk for surgical aortic valve replacement (SAVR). Over the past decade, extensive clinical evidence [...] Read more.
Transcatheter aortic valve implantation (TAVI) has emerged as a revolutionary therapeutic modality for the management of severe aortic stenosis (AS), particularly in patients who are at high or prohibitive risk for surgical aortic valve replacement (SAVR). Over the past decade, extensive clinical evidence has expanded the indications for TAVI to include intermediate- and low-risk populations, which usually represent a population of younger age, in which the most common complications of TAVI, including paravalvular leak (PVL) and pacemaker implantation, should be avoided. This review focuses on the incidence and predictors of PVL in various types of TAVI implantation, its clinical implication, and the prevention strategies to tackle this complication. Full article
(This article belongs to the Special Issue Transcatheter and Surgical Approaches to Complications of Transcatheter Procedures: Current Trends and Future Challenges)
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Other

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42 pages, 3764 KB  
Systematic Review
Beyond Conventional Meta-Analysis: A Meta-Learning Model to Predict Cohort-Level Mortality After Transcatheter Aortic Valve Replacement (TAVR)
by Yamil Liscano, Darly Martinez Guevara, Gustavo Andrés Urriago-Osorio and John Quintana
J. Cardiovasc. Dev. Dis. 2025, 12(10), 376; https://doi.org/10.3390/jcdd12100376 - 24 Sep 2025
Viewed by 861
Abstract
Context and Objective: Post-Transcatheter Aortic Valve Replacement (TAVR) mortality exhibits extreme heterogeneity that conventional meta-analyses fail to explain, limiting the clinical utility of evidence synthesis and hindering accurate prognostic assessment. This study evaluated whether meta-learning, using aggregate data from the literature, can predict [...] Read more.
Context and Objective: Post-Transcatheter Aortic Valve Replacement (TAVR) mortality exhibits extreme heterogeneity that conventional meta-analyses fail to explain, limiting the clinical utility of evidence synthesis and hindering accurate prognostic assessment. This study evaluated whether meta-learning, using aggregate data from the literature, can predict cohort-level mortality and identify its determinants, overcoming the limitations of traditional methods to provide a clearer understanding of the factors driving TAVR outcomes. Methods: A systematic review following PRISMA guidelines was conducted across five databases. Methodological quality was assessed with standardized tools (Risk of Bias 2, Newcastle-Ottawa Scale, Risk of Bias in Non-randomized Studies of Exposure). After performing conventional meta-analyses and meta-regressions, multiple machine learning models were trained using study-level characteristics as predictors. Advanced optimization with regularization and ensemble techniques was applied to develop a final, optimized model. Results: Fifty-eight studies, encompassing over 533,000 patients, were included. Traditional meta-analysis confirmed extreme heterogeneity (I2 = 76.7% in Random Clinical Trials, 96.8% in observational studies), with no explanatory power via meta-regression. The initial AdaBoost model achieved R2 = 0.191, outperforming 17 alternative algorithms. Advanced optimization developed a Blend_Optimized model that explained 65.3% of the variability (R2 = 0.653), marking a substantial 46 percentage-point increase. Interpretability analysis identified four dominant predictors: Society of Thoracic Surgeons Predicted Risk of Operative Mortality (R2 = 0.300), Recruitment Year (R2 = 0.212), % Transfemoral (R2 = 0.201), and % Diabetes (R2 = 0.175), revealing a potent temporal gradient reflecting the evolution of medical practice. Conclusions: Meta-learning significantly surpasses traditional methods in extracting systematic signals from heterogeneous evidence. This study demonstrates that, in addition to patient risk factors, a significant temporal gradient models technological evolution and learning curves. The methodology transforms seemingly unexplained heterogeneity into clinically interpretable patterns, demonstrating the potential of meta-learning as a complementary tool for evidence synthesis in interventional cardiology and opening avenues for applications in other complex cardiovascular fields. Important Limitation: This model predicts cohort-level outcomes and should not be used for individual risk assessment. Full article
(This article belongs to the Special Issue Transcatheter and Surgical Approaches to Complications of Transcatheter Procedures: Current Trends and Future Challenges)
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9 pages, 455 KB  
Protocol
Transfemoral Transcatheter Aortic Valve Implantation at Hospitals Without On-Site Cardiac Surgery (TAVI at Home): A Multicenter Prospective Interventional Study
by Miriam Compagnone, Gianni Dall’Ara, Simone Grotti, Greta Mambelli, Elisabetta Fabbri, Carlo Savini, Marco Balducelli, Andrea Santarelli, Elia Iorio, Beatriz Vaquerizo, Alfredo Marchese, Giuseppe Tarantini, Francesco Saia, Chiara Zingaretti, Carolina Moretti, Caterina Cavazza, Bernadette Vertogen, Filippo Ottani, Andrea Rubboli, Oriana Nanni, Carmine Pizzi, Marcello Galvani and Fabio Felice Tarantinoadd Show full author list remove Hide full author list
J. Cardiovasc. Dev. Dis. 2025, 12(2), 63; https://doi.org/10.3390/jcdd12020063 - 10 Feb 2025
Cited by 4 | Viewed by 2086
Abstract
Transcatheter aortic valve implantation (TAVI) has become the standard of care for elderly patients with aortic stenosis. International guidelines recommend that TAVI should be performed only in centers with on-site cardiac surgery (CS). However, rapidly evolving TAVI technology and increasing operator expertise have [...] Read more.
Transcatheter aortic valve implantation (TAVI) has become the standard of care for elderly patients with aortic stenosis. International guidelines recommend that TAVI should be performed only in centers with on-site cardiac surgery (CS). However, rapidly evolving TAVI technology and increasing operator expertise have significantly reduced peri-procedural complications, including those requiring rescue surgery, which occur in less than 0.5% of cases. Furthermore, only a minority of major complications are treated with CS, and the outcomes remain unfavorable. TAVI in centers without CS could represent a solution to reduce waiting times and ensure continuity of care for fragile patients. “TAVI at Home” is a single-arm prospective interventional study. According to sample size calculations based on literature data, the study aims to enroll a total of 200 patients, beginning with a run-in phase of 20 patients to establish safety. The primary endpoint is 30-day all-cause mortality. Secondary endpoints include technical success and the evaluation of single complications 30 days after the procedure. Hospitals without CS that are eligible to perform TAVI must have a high volume of coronary percutaneous interventions, operators with established TAVI experience, collaboration with vascular surgeons, and regular Heart Team meetings to ensure rigorous patient selection. Full article
(This article belongs to the Special Issue Transcatheter and Surgical Approaches to Complications of Transcatheter Procedures: Current Trends and Future Challenges)
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