Annular Rupture During Transcatheter Aortic Valve Implantation: Predictors, Management and Outcomes

Abstract

Transcatheter aortic valve implantation (TAVI) is the treatment of choice in patients with symptomatic severe aortic stenosis who are either inoperable or at high risk for conventional surgical aortic valve replacement. Recent data have also shown favourable outcomes in patients deemed to be at intermediate operative risk, which expands the application of this novel technology. Despite its success, TAVI has been associated with rare life-threatening complications. Of these, aortic annular rupture is considered to be the most devastating. Advances in pre-procedural screening and patient selection have reduced the incidence of annular rupture. When this complication occurs, early recognition and prompt management are essential. This article is intended to provide a comprehensive review of the predictors, management and clinical outcomes of aortic annular rupture.

Successful Bail-Out for a Migrated Self-Expandable Transcatheter Heart Valve Stuck in the Sinus of Valsalva

“…Regarding the selection of the THV, we chose a self-expandable THV because a balloon-expandable valve is known to have a higher risk of annulus rupture in the context of heavily calcified LVOT than a self-expandable THV. 7) Even with a self-expandable THV, however, there was still a high possibility of post-balloon dilatation for under-expanded self-expandable THV and a risk of annulus rupture at the time of post-balloon dilatation in this case. A balloon-expandable THV with slow and underfilling deployment might have been an option as well.…”

Spontaneous thrombosis of a transcatheter aortic valve replacement‐induced aortic root pseudoaneurysm

“…Also patients treated with a balloon‐expandable valve and THV/annulus oversizing ≥20% tend to be at higher risk for rupture, 6 as well as those cases that undergo a more aggressive THV postdilatation 7 . On the other hand, self‐expandable valves have been reported to be less associated with annulus rupture 8 . In this study, we describe a case where a contained aortic root perforation occurred despite a conservative predilatation, the use of a self‐expandable THV and no need or use of postdilatation.…”

Calcium Assessment, Correct Sizing, and Care With Balloons

“…If balloon dilatation is required, do not exceed the mean diameter of the LVOT or sinotubular junction (whichever is smaller). A balloon-to-artery ratio of 1 can be used for semicompliant balloons and <1 for noncompliant balloons ( 10 ). Adopting a slow 2-step deployment is an alternative technique to reduce the risk of annular rupture using balloon expandable valves in the presence of adverse anatomical features.…”