Table 1.

Causes of Severe Intraoperative Hypotension During TAVR (and Other Less Acute Complications)

Condition	Treatment	Comment
(1) Retroperitoneal bleeding from iliac artery access site rupture	Balloon occlusion	Precise imaging of access ileofemoral vessels can decrease the likelihood of this complication
	Surgical control
(2) Aortic dissection or rupture	Surgical control will likely be necessary, although this scenario is often lethal	Avoid oversizing, overballooning
(3) Pericardial tamponade	Pericardial drainage or open surgical control may be required, depending on scenario	Causes range from RV wire perforation to LV wire perforation, to aortic or LV rupture
(4) Coronary ostial obstruction	Percutaneous angioplasty may occasionally be of benefit	Components of valve, or, more likely, a bulky leaflet atheroma may overlie and occlude a coronary os
	Surgical conversion is often necessary
(5) Acute severe aortic insufficiency	A second transcatheter valve may need to be delivered	Usually due to “frozen leaflet”
	Surgical conversion may be necessary
Apical access site problems	Surgical control	Late pseudoaneurysm may result
Internal cardiac tears (VSD or LV to LA fistula)	Individualized
Acute mitral insufficiency	Surgery may be required	From chordal tear during antegrade apical approach
Positioning and deployment problems	Individualized
Stroke	Multifactorial
Acute kidney injury	Multifactorial
Conduction disturbances	Close monitoring	More commonly noted with Medtronic CoreValve device
	Pacemaker as needed
Suicidal LV	Fluid administration

VSD, ventricular septal defect; LV, left ventricle (ventricular); LA, left atrium.