AM cardiology report pearls 5/24: TAVR complications and digoxin toxicity

Indications for TAVR: severe AS and inoperable or high risk for operation. 30% of patients with severe AS meet indications for TAVR. (note, bicuspid valve is currently an indication)

 

Two types of TAVR valves:

  • Balloon expandable (Edwards valve) – the current generation of Edwards valves have a sleeve. This decreases the risk of aortic insufficiency but increases the risk of conduction abnormalities (10% of patients need a PPM!)
  • Self-expanding (Core valve)

 

Complications of TAVR: YY’s approach is to break this down into acute vs chronic complications, and under each category, think about complications of the access site vs the valve itself. The three main numbers to know are: <1% mortality, 2.5% risk of stroke, and 10% risk of heart block requiring PPM

  • Acute complications:
    • Access site
      • Bleeding
      • Perforation
    • Valve
      • Aortic root rupture
      • Valve embolization (LV, aorta)
      • Stroke (2.5% risk!)
      • Aortic insufficiency
      • Mitral stenosis
      • Ventricular perforation (1%)
    • Chronic complications
      • Access site
        • Infection
        • Bleeding
      • Valve
        • Heart block (10%)
        • LV dysfunction
        • Pericardial effusion
        • Infection

 

Digoxin toxicity:

  • Acutely, patients commonly p/w AMS, GI symptoms
  • Arrhythmias are the most dangerous toxicity – and patients can have virtually any type of arrhythmia! A few we discussed at report:
    • Regularized afib
    • Junctional rhythms
    • Alternating BBB
    • VT/VF
  • Digoxin levels NOT meaningful!
  • Give digibind if there are unstable/life-threatening arrhythmias

 

Evernote: https://www.evernote.com/shard/s34/sh/e49b8469-fa38-489d-a5ba-1720b65a8388/9f51cc630f6f9e8c0db445e40a3d4274

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