Screening, complications and outcome of aortic valve implantation

Transcatheter aortic valve implantation (TAVI) has been fully integrated as a therapeutic option for patients with aortic valve stenosis. This thesis focuses on screening, complications and outcome of aortic valve implantation, mainly by TAVI.
The first section concentrates on computed tomography angiography (CTA) in screening prior to TAVI. Intravenous hydration is used to mitigate the effects of contrast media administered during CTA. We found no significant difference on renal outcome between conventional, long, hydration compared to shorter hydration. We also demonstrated that the presence of potentially malignant incidental findings, described on pre-TAVI CTA, is an independent predictor of (non-cardiovascular) mortality.
In the second section, periprocedural complications are evaluated. Histopathologic analyses of thrombectomy material in 3 cases of thromboembolic complications after TAVI are described. Additionally we demonstrated that also with the newest prosthesis, vascular complications after TAVI remain an issue.
The third section focuses on clinical outcome. We used 4D flow magnetic resonance imaging (MRI) to analyze the hemodynamic performance of two bioprostheses types 1-year after surgical aortic valve replacement. Moreover, we evaluated procedural outcome after TAVI with two different prostheses in a low to intermediate surgical risk population and described the trends in patient-, procedural characteristics and outcome after TAVI over the last 8-years. Finally, we provide an overview of autopsy findings in patients with TAVI in their medical history and the added value of autopsy over a solely clinical determined cause of death was demonstrated.
In the final part of the thesis the findings and future considerations are discussed.