TY - JOUR
T1 - Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement
AU - Barbanti, Marco
AU - Yang, Tae Hyun
AU - Rodès Cabau, Josep
AU - Tamburino, Corrado
AU - Wood, David A.
AU - Jilaihawi, Hasan
AU - Blanke, Phillip
AU - Makkar, Raj R.
AU - Latib, Azeem
AU - Colombo, Antonio
AU - Tarantini, Giuseppe
AU - Raju, Rekha
AU - Binder, Ronald K.
AU - Nguyen, Giang
AU - Freeman, Melanie
AU - Ribeiro, Henrique B.
AU - Kapadia, Samir
AU - Min, James
AU - Feuchtner, Gudrun
AU - Gurtvich, Ronen
AU - Alqoofi, Faisal
AU - Pelletier, Marc
AU - Ussia, Gian Paolo
AU - Napodano, Massimo
AU - De Brito, Fabio Sandoli
AU - Kodali, Susheel
AU - Norgaard, Bjarne L.
AU - Hansson, Nicolaj C.
AU - Pache, Gregor
AU - Canovas, Sergio J.
AU - Zhang, Hongbin
AU - Leon, Martin B.
AU - Webb, John G.
AU - Leipsic, Jonathon
PY - 2013/7/16
Y1 - 2013/7/16
N2 - 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.
AB - 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.
KW - Annular calcification
KW - Annular rupture
KW - Multidetector computed tomography
KW - Transcatheter heart valves
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U2 - 10.1161/CIRCULATIONAHA.113.002947
DO - 10.1161/CIRCULATIONAHA.113.002947
M3 - Article
C2 - 23748467
AN - SCOPUS:84880355851
SN - 0009-7322
VL - 128
SP - 244
EP - 253
JO - Circulation
JF - Circulation
IS - 3
ER -