Anatomical and Procedural Features Associated With Aortic Root Rupture During Balloon-Expandable Transcatheter Aortic Valve Replacement

• Published in: Circulation (New York, N.Y.) Vol. 128; no. 3; pp. 244 - 253
• Main Authors: Barbanti, Marco, Yang, Tae-Hyun, Rodès Cabau, Josep, Tamburino, Corrado, Wood, David A., Jilaihawi, Hasan, Blanke, Phillip, Makkar, Raj R., Latib, Azeem, Colombo, Antonio, Tarantini, Giuseppe, Raju, Rekha, Binder, Ronald K., Nguyen, Giang, Freeman, Melanie, Ribeiro, Henrique B., Kapadia, Samir, Min, James, Feuchtner, Gudrun, Gurtvich, Ronen, Alqoofi, Faisal, Pelletier, Marc, Ussia, Gian Paolo, Napodano, Massimo, de Brito, Fabio Sandoli, Kodali, Susheel, Norgaard, Bjarne L., Hansson, Nicolaj C., Pache, Gregor, Canovas, Sergio J., Zhang, Hongbin, Leon, Martin B., Webb, John G., Leipsic, Jonathon
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD by the American College of Cardiology Foundation and the American Heart Association, Inc 16.07.2013; Lippincott Williams & Wilkins
• Subjects: Aged; Aged, 80 and over; Angioplasty, Balloon - adverse effects; Aortic Rupture - diagnostic imaging; Aortic Rupture - epidemiology; Aortic Rupture - etiology; Aortic Valve - diagnostic imaging; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - epidemiology; Aortic Valve Stenosis - therapy; Biological and medical sciences; Blood and lymphatic vessels; Calcinosis - complications; Calcinosis - diagnostic imaging; Calcinosis - epidemiology; Cardiac Catheterization; Cardiology. Vascular system; Cohort Studies; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Humans; Logistic Models; Male; Medical sciences; Predictive Value of Tests; Risk Factors; Tomography, X-Ray Computed; annular calcification; annular rupture; Radiodiagnosis; Root; transcatheter heart valves; Rupture; Cardiovascular disease; Heart valve; Artery; Multidetector scanner; Association; Treatment; Blood vessel; Sounding balloon; Surgery; multidetector computed tomography; Calcification; Medical imagery; Aorta; Computerized axial tomography; Circulatory system; Cardiology; Aortic valve
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.113.002947

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.