Specification for postoperative care and treatment after transcatheter aortic valve replacement (TAVR)_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Peide ¹ , FAN Yuxin ² , XU Mian ² , LIU Siyu ² , ZHAO Guangzhi ³ ,  CHANG Shuo ²

1. Department of Cardiac Intensive Care Unit, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100037, P. R. China;
2. Department of Surgical Intensive Care Unit, Fuwai Yunnan Cardiovascular Hospital, Cardiovascular Hospital Affiliated to Kunming Medical University, Kunming, 650102, P. R. China;
3. Department of Structural Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100037, P. R. China;

Corresponding author：

CHANG Shuo, Email: cschl@126.com

Keywords：

Transcatheter aortic valve replacement (TAVR); postoperative care; complication treatment; treatment specification

DOI：

10.7507/1007-4848.202504093

Video：

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Since the first successful transcatheter aortic valve replacement (TAVR) was performed globally in 2002, the TAVR technology has become increasingly mature. With more than a decade of development in our country, its application experience, device research and development, procedural improvements, evidence-based medicine, and guideline updates have continuously progressed, leading to a significant increase in the number of procedures conducted. Compared to traditional surgical operations, TAVR has different postoperative monitoring points and principles for the prevention and management of complications, necessitating the formulation of corresponding monitoring and treatment protocols that align with the technical characteristics of the procedure. This guideline is based on clinical practice and incorporates both domestic and international literature as well as the experiences of Fuwai Hospital. It distills and organizes routine postoperative monitoring practices, process optimization, and complication management for TAVR, establishing a set of practical guidelines for postoperative monitoring in China. These guidelines have strong practical value for optimizing postoperative management strategies and preventing and managing complications, which is beneficial for early functional recovery of patients, shortening hospital stays, and reducing complication rates. They provide guidance and reference for domestic peers and support the standardized development and quality improvement of postoperative management for TAVR in China.

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10.	Ten Berg J, Sibbing D, Rocca B, et al. Management of antithrombotic therapy in patients undergoing transcatheter aortic valve implantation: A consensus document of the ESC Working Group on Thrombosis and the European Association of Percutaneous Cardiovascular Interventions (EAPCI), in collaboration with the ESC Council on Valvular Heart Disease. Eur Heart J, 2021, 42(23): 2265-2269.
11.	中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 经导管主动脉瓣植入术后抗血栓治疗中国专家共识. 中华心血管病杂志, 2022, 50(2): 117-131.Chinese Society of Cardiology, Chinese Medical Association, Editorial Board of Chinese Journal of. Cardiology. Chinese expert consensus on antithrombotic therapy after transcatheter aortic valve implantation. Chin J Cardiol, 2022, 50(2): 117-131.
12.	国家心血管病中心, 国家结构性心脏病介入质控中心, 中华医学会心血管病学分会, 等. 经导管主动脉瓣置换术临床实践指南. 中华医学杂志, 2023, 103(12): 886-900.National Center for Cardiovascular Diseases, National Center for Quality Control of Structural Heart Disease Intervention, Chinese Society of Cardiology, et al. Chinese guideline for the clinical application of transcatheter aortic valve replacement. Natl Med J China. 2023, 103(12): 886-900.
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15.	Yu Q, Fu Q, Xia Y, et al. Predictors, clinical impact, and management strategies for conduction abnormalities after transcatheter aortic valve replacement: An updated review. Front Cardiovasc Med, 2024, 11: 1370244.
16.	Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J, 2021, 42(35): 3427-3520.
17.	Matthew W, Sherwood, Katelyn, et al. Incidence, temporal trends, and associated outcomes of vascular and bleeding complications in patients undergoing transfemoral transcatheter aortic valve replacement: Insights from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry. Circ Cardiovasc Interv, 2020, 13(1): e008227.
18.	范嘉祺, 刘先宝, 艾丽菲热·艾合买提, 等. 经导管主动脉瓣置换术围术期冠状动脉闭塞的评估和处理流程. 中国介入心脏病学杂志, 2023, 31(6): 461-466.Fan JQ, Liu XB, Ailifeire·aihemaiti, et al. Perioperative evaluation and management of coronary obstruction in transcatheter aortic valve replacement. Chin J Interv Cardiol, 2023, 31(6): 461-466.
19.	Wunderlich NC, Honold J, Swaans MJ, et al. How to image and manage prosthesis-related complications after transcatheter aortic valve replacement. Curr Cardiol Rep, 2021, 23(8): 94.
20.	Zou Q, Wei Z, Sun S. Complications in transcatheter aortic valve replacement: A comprehensive analysis and management strategies. Curr Probl Cardiol, 2024, 49(5): 102478.
21.	Toggweiler S, Leipsic J, Binder RK, et al. Management of vascular access in transcatheter aortic valve replacement: Part 2: Vascular complications. JACC Cardiovasc Interv, 2013, 6(8): 767-776.
22.	Habertheuer A, Gleason TG, Kilic A, et al. Impact of perioperative stroke on midterm outcomes after transcatheter aortic valve replacement. Ann Thorac Surg, 2020, 110: 1294-1301.
23.	Huded CP, Tuzcu EM, Krishnaswamy A, et al. Association between transcatheter aortic valve replacement and early postprocedural stroke. JAMA, 2019, 321: 2306-2315.
24.	Avvedimento M, Cepas-Guillén P, Garcia CB, et al. Incidence, predictors, and prognostic impact of neurologic events after TAVR according to VARC-3 criteria. JACC Cardiovasc Interv, 2024, 17(15): 1795-1807.

1. 潘文志, 方雁行, 李捷, 等. 经导管主动脉瓣置换术2023年度报告. 中国胸心血管外科临床杂志, 2024, 31(4): 498-503.Pan WZ, Fang YX, Li J, et al. Transcatheter aortic valve replacement (TAVR) annual report 2023. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(4): 498-503.
2. Bansal A, Puri R, Yun J, et al. Management of complications after valvular interventions. EuroIntervention, 2025, 21(8): e390-e410.
3. Charlesworth M, Williams BG, Buch MH. Advances in transcatheter aortic valve implantation, part 2: Perioperative care. BJA Educ, 2021, 21(7): 264-269.
4. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guideline. Circulation, 2021, 143(5): e35-e71.
5. Vahanian A, Beyersdorf F, Praz F, et al. ESC/EACTS Scientific Document Group. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
6. 中国医师协会心血管内科医师分会结构性心脏病学组, 亚太结构性心脏病俱乐部. 中国经导管主动脉瓣置换术临床路径专家共识(2024版). 中国循环杂志, 2024, 39(11): 1041-1057.Expert Consensus on Clinical Pathway for Transcatheter Aortic Valve Replacement in China Structural Cardiology Committee of Cardiovascular Physicians Branch, Chinese Medical Doctor Association, Asia Pacific Structural Heart Disease Club. 2024 expert consensus on clinical pathway for transcatheter aortic valve replacement in China. Chin Circ J, 2024, 39(11): 1041-1057.
7. 张海涛, 曹芳芳. 心脏重症相关高血压管理专家共识的解读. 中国循环杂志, 2019, 34(S01): 96-97.Zhang HT, Cao FF. Interpretation of expert consensus on management of hypertension related to severe heart disease. Chin Circ J, 2019, 34(S01): 96-97.
8. Gasior T. 2024 update on cerebral embolic protection after transcatheter aortic valve replacement. J Clin Med, 2024, 13: 7256.
9. Grover FL, Vemulapalli S, Carroll JD, et al. 2016 Annual report of the Society of Thoracic Surgeons/American College of Cardiology transcatheter valve therapy registry. J Am Coll Cardiol, 2017, 69(10): 1215-1230.
10. Ten Berg J, Sibbing D, Rocca B, et al. Management of antithrombotic therapy in patients undergoing transcatheter aortic valve implantation: A consensus document of the ESC Working Group on Thrombosis and the European Association of Percutaneous Cardiovascular Interventions (EAPCI), in collaboration with the ESC Council on Valvular Heart Disease. Eur Heart J, 2021, 42(23): 2265-2269.
11. 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 经导管主动脉瓣植入术后抗血栓治疗中国专家共识. 中华心血管病杂志, 2022, 50(2): 117-131.Chinese Society of Cardiology, Chinese Medical Association, Editorial Board of Chinese Journal of. Cardiology. Chinese expert consensus on antithrombotic therapy after transcatheter aortic valve implantation. Chin J Cardiol, 2022, 50(2): 117-131.
12. 国家心血管病中心, 国家结构性心脏病介入质控中心, 中华医学会心血管病学分会, 等. 经导管主动脉瓣置换术临床实践指南. 中华医学杂志, 2023, 103(12): 886-900.National Center for Cardiovascular Diseases, National Center for Quality Control of Structural Heart Disease Intervention, Chinese Society of Cardiology, et al. Chinese guideline for the clinical application of transcatheter aortic valve replacement. Natl Med J China. 2023, 103(12): 886-900.
13. Biancari F, Pykäri J, Savontaus M, et al. Early and late pace-maker implantation after transcatheter and surgical aortic valve replacement. Catheter Cardiovasc Interv, 2021, 97(4): E560-E568.
14. Mohammadi NSH, Tavakoli K, Taebi M, et al. Comparative prognostic value of risk factors for predicting pacemaker implantation after transcatheter aortic valve replacement: A systematic review and network meta-analysis. Am J Cardiol, 2025, S0002-9149(25): 00296-6.
15. Yu Q, Fu Q, Xia Y, et al. Predictors, clinical impact, and management strategies for conduction abnormalities after transcatheter aortic valve replacement: An updated review. Front Cardiovasc Med, 2024, 11: 1370244.
16. Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J, 2021, 42(35): 3427-3520.
17. Matthew W, Sherwood, Katelyn, et al. Incidence, temporal trends, and associated outcomes of vascular and bleeding complications in patients undergoing transfemoral transcatheter aortic valve replacement: Insights from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry. Circ Cardiovasc Interv, 2020, 13(1): e008227.
18. 范嘉祺, 刘先宝, 艾丽菲热·艾合买提, 等. 经导管主动脉瓣置换术围术期冠状动脉闭塞的评估和处理流程. 中国介入心脏病学杂志, 2023, 31(6): 461-466.Fan JQ, Liu XB, Ailifeire·aihemaiti, et al. Perioperative evaluation and management of coronary obstruction in transcatheter aortic valve replacement. Chin J Interv Cardiol, 2023, 31(6): 461-466.
19. Wunderlich NC, Honold J, Swaans MJ, et al. How to image and manage prosthesis-related complications after transcatheter aortic valve replacement. Curr Cardiol Rep, 2021, 23(8): 94.
20. Zou Q, Wei Z, Sun S. Complications in transcatheter aortic valve replacement: A comprehensive analysis and management strategies. Curr Probl Cardiol, 2024, 49(5): 102478.
21. Toggweiler S, Leipsic J, Binder RK, et al. Management of vascular access in transcatheter aortic valve replacement: Part 2: Vascular complications. JACC Cardiovasc Interv, 2013, 6(8): 767-776.
22. Habertheuer A, Gleason TG, Kilic A, et al. Impact of perioperative stroke on midterm outcomes after transcatheter aortic valve replacement. Ann Thorac Surg, 2020, 110: 1294-1301.
23. Huded CP, Tuzcu EM, Krishnaswamy A, et al. Association between transcatheter aortic valve replacement and early postprocedural stroke. JAMA, 2019, 321: 2306-2315.
24. Avvedimento M, Cepas-Guillén P, Garcia CB, et al. Incidence, predictors, and prognostic impact of neurologic events after TAVR according to VARC-3 criteria. JACC Cardiovasc Interv, 2024, 17(15): 1795-1807.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesSpecification for postoperative care and treatment after transcatheter aortic valve replacement (TAVR)

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