6533b829fe1ef96bd128a599
RESEARCH PRODUCT
Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement
Martin B. LeonMarc P. PelletierGregor PachePhillip BlankeJosep Rodes CabauBjarne L. NørgaardRaj MakkarSusheel KodaliMelanie FreemanHenrique Barbosa RibeiroRonen GurtvichJames K. MinGiang NguyenHasan JilaihawiSamir R. KapadiaHongbin ZhangDavid A. WoodRonald K. BinderCorrado TamburinoJonathon LeipsicSergio CánovasJohn G. WebbAzeem LatibMassimo NapodanoNicolaj C. HanssonMarco BarbantiAntonio ColomboFabio Sandoli De BritoGian Paolo UssiaRekha RajuGiuseppe TarantiniTae Hyun YangGudrun FeuchtnerFaisal Alqoofisubject
Malemedicine.medical_specialtyCardiac CatheterizationTranscatheter aorticAortic rootmedicine.medical_treatmentAortic Rupturemultidetector computed tomographySettore MED/11 - Malattie dell'Apparato CardiovascolareCohort StudiesValve replacementPredictive Value of TestsRisk FactorsPhysiology (medical)Internal medicineMultidetector computed tomographymedicine80 and overVentricular outflow tractHumanscardiovascular diseasesannular calcification; annular rupture; multidetector computed tomography; transcatheter heart valves; Aged; Aged 80 and over; Angioplasty Balloon; Aortic Rupture; Aortic Valve; Aortic Valve Stenosis; Calcinosis; Cohort Studies; Female; Heart Valve Prosthesis Implantation; Humans; Logistic Models; Male; Predictive Value of Tests; Risk Factors; Tomography X-Ray Computed; Cardiac CatheterizationTomographyAgedAged 80 and overHeart Valve Prosthesis Implantationbusiness.industrySinotubular JunctionAngioplastyCalcinosisAortic Valve Stenosismedicine.diseaseX-Ray ComputedBalloon expandable stentLogistic Modelstranscatheter heart valvesAortic ValveCardiologycardiovascular systemannular ruptureFemaleRadiologyCardiology and Cardiovascular MedicinebusinessTomography X-Ray ComputedAngioplasty BalloonBalloonCalcificationannular calcificationdescription
Background— Aortic root rupture is a major concern with balloon-expandable transcatheter aortic valve replacement (TAVR). We sought to identify predictors of aortic root rupture during balloon-expandable TAVR by using multidetector computed tomography. Methods and Results— Thirty-one consecutive patients who experienced left ventricular outflow tract (LVOT)/annular/aortic contained/noncontained rupture during TAVR were collected from 16 centers. A caliper-matched sample of 31 consecutive patients without annular rupture, who underwent pre-TAVR multidetector computed tomography served as a control group. Multidetector computed tomography assessment included short- and long-axis diameters and cross-sectional area of the sinotubular junction, annulus, and LVOT, and the presence, location, and extent of calcification of the LVOT, as well. There were no significant differences between the 2 groups in any preoperative clinical and echocardiographic variables. Aortic root rupture was identified in 20 patients and periaortic hematoma in 11. Patients with root rupture had a higher degree of subannular/LVOT calcification quantified by the Agatston score (181.2±211.0 versus 22.5±37.6, P <0.001), and a higher frequency of ≥20% annular area oversizing (79.4% versus 29.0%, P <0.001) and balloon postdilatation (22.6% versus 0.0%, P =0.005). In conditional logistic regression analysis for the matched data, moderate/severe LVOT/subannular calcifications (odds ratio, 10.92; 95% confidence interval, 3.23–36.91; P <0.001) and prosthesis oversizing ≥20% (odds ratio, 8.38; 95% confidence interval, 2.67–26.33; P <0.001) were associated with aortic root contained/noncontained rupture. Conclusions— This study demonstrates that LVOT calcification and aggressive annular area oversizing are associated with an increased risk of aortic root rupture during TAVR with balloon-expandable prostheses. Larger studies are warranted to confirm these findings.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2013-07-01 |