**10. Complications**

As in any procedure, complications with TAVR can occur intra- and postprocedure. Some common complications include: (1) valve function (Paravalvular leakage (PVL)), (2) vascular access/bleeding complications (injury at arterial access site and/or vascular closure problems), (3) valve deployment (including malpositioning, annular rupture), (4) organ injuries (such as stroke, myocardial ischemia/injury, and acute kidney injury), (5) arrhythmic abnormalities like highdegree atrioventricular block and atrial fibrillation, and (6) in some cases death.

#### **10.1 Paravalvular aortic regurgitation**

Longer-Term complications include PVR. Patients with moderate and severe PVR had a three-time increase in 30-day mortality. Diagnosis of PVR includes multiple modalities such as doppler echocardiography, cardiac magnetic resonance, and angiography.

#### **10.2 Vascular access bleeding**

Access complications 30 days post procedure have ranged from 11% for high-risk cohorts [51]. Risk factors include severe tortuosity, percutaneous preclosure device failure, sheath-to-artery ratio, and presence of circumferential calcification. A mechanical factor that may increase bleeding risk is use of large delivery catheters. Of the various techniques, the transapical approach has been associated with related risk of myocardial tears [52]. Due to new technological advances, newer TAVR devices now have a 14F inner diameter instead of a 24–26F inner diameter sheaths required in the first TAVR systems. This has correlated with a decrease in vascular complications by 11–14%.
