Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement

Marco Barbanti, Tae Hyun Yang, Josep Rodès Cabau, Corrado Tamburino, David A. Wood, Hasan Jilaihawi, Phillip Blanke, Raj R. Makkar, Azeem Latib, Antonio Colombo, Giuseppe Tarantini, Rekha Raju, Ronald K. Binder, Giang Nguyen, Melanie Freeman, Henrique B. Ribeiro, Samir Kapadia, James Min, Gudrun Feuchtner, Ronen GurtvichFaisal Alqoofi, Marc Pelletier, Gian Paolo Ussia, Massimo Napodano, Fabio Sandoli De Brito, Susheel Kodali, Bjarne L. Norgaard, Nicolaj C. Hansson, Gregor Pache, Sergio J. Canovas, Hongbin Zhang, Martin B. Leon, John G. Webb, Jonathon Leipsic

Research output: Contribution to journalArticlepeer-review

374 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)244-253
Number of pages10
Issue number3
StatePublished - Jul 16 2013
Externally publishedYes


  • Annular calcification
  • Annular rupture
  • Multidetector computed tomography
  • Transcatheter heart valves

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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