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

Alqoofi, F

Barbanti, M

Binder, Rk

Blanke, P

Canovas, Sj

Colombo, A

de Brito FS, Jr

Feuchtner, G

Freeman, M

Gurtvich, R

Hansson, Nc

Jilaihawi, H

Kapadia, S

Kodali, S

Latib, A

Leipsic, J.

Leon, Mb

Makkar, Rr

Min, J

Napodano, Massimo

Nguyen, G

Norgaard, Bl

Pache, G

Pelletier, M

Raju, R

Ribeiro, Hb

Rod\ue8s Cabau, J

Tamburino, C

Tarantini, Giuseppe

Ussia, Gp

Webb, Jg

Wood, Da

Yang, Th

Zhang, H

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

Barbanti M

Yang TH

Rodès Cabau J

Tamburino C

Wood DA

Jilaihawi H

Blanke P

Makkar RR

Latib A

Colombo A

Raju R

Binder RK

Nguyen G

Freeman M

Ribeiro HB

Kapadia S

Min J

Feuchtner G

Gurtvich R

Alqoofi F

Pelletier M

Ussia GP

de Brito FS Jr

Kodali S

Norgaard BL

Hansson NC

Pache G

Canovas SJ

Zhang H

Leon MB

Webb JG

Leipsic J.

TARANTINI, GIUSEPPE

NAPODANO, MASSIMO

Archivio istituzionale della ricerca - Università di Padova

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

Yang, T

Rodes Cabau, J

Wood, D

Makkar, R

Tarantini, G

Binder, R

Ribeiro, H

Ussia, G

Napodano, M

Jr, D

Norgaard, B

Hansson, N

Canovas, S

Leon, M

Webb, J

Cineca Institutional Research Information System

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

Barbanti , M

Yang, TH

Jr, Dbf

Archivio della Ricerca - Università di Roma Tor vergata

Webb, J.

USSIA, GIAN PAOLO

English

https://art.torvergata.it/retrieve/handle/2108/134831/277714/Circulation-2013-ussia.pdf

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

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Archivio istituzionale della ricerca - Università di Padova

Cineca Institutional Research Information System

Archivio della Ricerca - Università di Roma Tor vergata

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