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

Barbanti, Marco; Yang, Tae Hyun; Cabau, Josep Rodés; Tamburino, Corrado; Wood, David; Jilaihawi, Hasan; Blanke, Phillip; Makkar, Raj; Latib, Azeem; Colombo, Antonio; Tarantini, Giuseppe; Raju, Rekha; Binder, Ronald K.; Nguyen, Giang D.; Freeman, Mélanie; Ribeiro, Henrique Barbosa; Kapadia, Samir; Min, James K.; Feuchtner, Gudrun; Gurtvich, Ronen; Alqoofi, Faisal; Pelletier, Marc; Ussia, Gian Paolo; Napodano, Massimo; Brito, Fábio Sândoli de; Kodali, Susheel; Nørgaard, Bjarne Linde; Hansson, Nicolaj C.; Pache, Gregor; Cánovas, Sergio; Zhang, Hongbin; Leon, Martin B.; Webb, John G.; Leipsic, Jonathon

doi:10.1161/circulationaha.113.002947

Cited by 500 publications

(337 citation statements)

References 24 publications

(33 reference statements)

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“…Fig. 3; [17,18]), severe asymmetric subvalvular hypertrophy, and global left ventricular hypertrophy in the elderly, especially in female patients with relatively weak myocardium.…”

Section: Aortic Annulus Rupturementioning

confidence: 99%

“…Aortic annulus rupture usually occurs because of poor patient selection, lack of experience, measurement error, aggressive dilatation, valve oversizing (>20% was shown to be associated with an 8.4-fold higher risk of contained and uncontained ruptures with the balloon-expandable system [17]), bulky calcifications in the valve deployment zone (. Fig.…”

Section: Aortic Annulus Rupturementioning

confidence: 99%

“…Whether patients with extensive calcification of the valve Selecting suitable patients and the correct size of the valve system via preoperative imaging assessment is important to reduce the rates of rupture. The rate of oversizing is recommended to be 5-20% when the Sapien XT system is used [17]. In cases of extreme calcification, an average rate of 7.5% is recommended [20] to balance the oversizing that may result in rupture and the undersizing that may result in increased paravalvular regurgitation.…”

Section: Aortic Annulus Rupturementioning

confidence: 99%

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Transcatheter aortic valve replacement with balloon-expandable valve

Shen

Zhang

et al. 2017

Herz

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Background Transcatheter aortic valve replacement (TAVR) is widely applied for the treatment of severe aortic stenosis (AS) in developed countries; however, in China, it is still in the early stage of utilization. On the basis of previous studies, this work explored the feasibility of TAVR in patients with severe AS in China and analyzed the cause of death in four cases. Methods This retrospective study included 20 patients who had severe AS and underwent TAVR with a balloon-expandable system (Edwards SAPIEN XT) in our hospital from January 2011 to June 2016. The valve and heart functions of 16 survivors before and after the TAVR procedure were compared. TAVR endpoints, device success, and adverse events were assessed according to the definitions of the Valve Academic Research Consortium-2 (VARC-2). Results There were 13 male and seven female patients aged 65–81 years (average, 73.15) who underwent TAVR. The TAVR approach was transfemoral in 19 patients and transapical in one patient. Four patients died (two of coronary artery occlusion and two of aortic annulus rupture) during the TAVR procedure or shortly after; six patients had mild paravalvular leakage, and the rest of the patients showed a significant improvement in cardiac function. During the follow-up period (2–62 months), one patient died of lung cancer 13 months after the TAVR procedure. Conclusion TAVR with a balloon-expandable system is safe and effective and can be used for patients with severe AS in China. It requires careful patient selection and preoperative assessment so as to reduce the 30-day postoperative mortality rate.

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“…Fig. 3; [17,18]), severe asymmetric subvalvular hypertrophy, and global left ventricular hypertrophy in the elderly, especially in female patients with relatively weak myocardium.…”

Section: Aortic Annulus Rupturementioning

confidence: 99%

Section: Aortic Annulus Rupturementioning

confidence: 99%

Section: Aortic Annulus Rupturementioning

confidence: 99%

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Transcatheter aortic valve replacement with balloon-expandable valve

Shen

Zhang

et al. 2017

Herz

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“…4) Furthermore, calcium in the aortic-valvular complex (AVC) is a well-known predictor of PVL, PD, and annulus injury following TAVI. [7][8][9][10][11] Importantly, device landing zone (DLZ) calcification has been shown to be a strong predictor of PVL, PD, annulus injury, and new PPMI after XT or CV implantations. 7,[10][11][12] It was particularly found to be related to PVL after BE-or SE-TAVI 7) and to predict aortic root injury following BE-TAVI, 11) if DLZ calcification was located inferior to the annulus region.…”

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confidence: 99%

Transcatheter Aortic Valve Implantation With Different Valve Designs for Severe Device Landing Zone Calcification

Maeno¹,

Abramowitz²,

Kazuno³

et al. 2017

Int. Heart J.

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SummarySevere device landing zone calcification (DLZ-CA) predicted paravalvular leak (PVL) and post-dilatation (PD) after transcatheter aortic valve implantation (TAVI). The aim of this study was to determine the influence of DLZ-CA on PVL or PD rates after SAPIEN XT (XT) versus CoreValve (CV).We analyzed patients undergoing TAVI who had severe DLZ-CA. Severe DLZ-CA defined the upper left ventricular outflow tract calcification; the cross-sectional region 2 mm inferior to the annular plane. PVL was evaluated at 30-days using transthoracic echocardiography. Overall, 133 patients had XT-TAVI and the remaining 41 patients had CV-TAVI. Two patients had annulus injury in the XT group (oversizing 20.2% and 20.5% for two XT cases). PD was less frequently performed in the XT group (34.1% versus 12.8%; P = 0.002), but PVL rates were similar between both groups (42.1% versus 41.5% for the XT and CV groups, respectively; P = 0.94). Importantly, excessive oversizing or the degree of filling volume was not associated with decreased PVL after XT-TAVI (P = non-significant for all). On multivariate analysis, CV-TAVI was found to be one of the independent predictors of need for PD (Odds ratio 3.63, 95% confidence interval 1.55 to 8.53, P = 0.003).In the setting of severe DLZ-CA, XT and CV have similar rates of PVL but XT had less need for PD. Excessive oversizing with XT carries a risk of root injury which could be further increased by DLZ-CA. (Int Heart J 2017; 58: 56-62)

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“…We used a 23mm valve due tosignificant focal calcification extending from annulus into LVOT. This meant high risk of Page 5 of 9 A c c e p t e d M a n u s c r i p t 5 aortic root rupture with a 26mm valve [3]. Alternatively an underfilled 26mm valve could have been considered.…”

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confidence: 99%