Coil embolization to successfully treat annular rupture during transcatheter aortic valve replacement

Abstract

Aortic annular rupture is one of the most feared complications of transcatheter aortic valve replacement (TAVR). This complication often presents as sudden cardiac tamponade with hypotension and requires urgent intervention. The traditional rescue strategy for such cases is emergency surgical intervention, yet the mortality remains high considering most patients who undergo TAVR are not candidates for open heart surgery. As such, there is a need for percutaneous alternatives to treat this critical complication. Here, we describe a case of annular rupture during TAVR that was successfully treated with coil embolization at the rupture site. This case illustrates the use of coil embolization as a treatment strategy in patients with acute aortic annular rupture who are at high-risk for surgical intervention.

Valve implantation for successful sealing of a balloon predilatation‐induced annular rupture during transcatheter aortic valve replacement

“…All of the previously reported TAVR-related annular ruptures were caused by deployment of a THV or balloon postdilatation. [4][5][6][7] There was one case in which a successful seal was achieved after transapical TAVR without any intraprocedural hemodynamic disturbances. 8 Two other reports concerned valve-in-valve sealed deployment-induced intra-annular rupture; the procedure failed in one case 9 and the patient in the other report developed an ischemic bowel and survived for only 3 days.…”

“…Therefore, catheter‐based options are needed. All of the previously reported TAVR‐related annular ruptures were caused by deployment of a THV or balloon postdilatation 4–7 . There was one case in which a successful seal was achieved after transapical TAVR without any intraprocedural hemodynamic disturbances 8 .…”

Percutaneous Management of a Contained Annular Rupture Occurring With Self-Expanding Transcatheter Aortic Valve Replacement

“…Risk factors have been described including subannular LVOT calcification, balloon-expandable valve oversizing, aggressive balloon post-dilation, and bicuspid anatomy, whereas the use of multislice CT has improved rates of TAVR complications including rupture ( 5 , 6 ). Uncontained rupture is managed with emergent surgery; however, there are prior case reports of the use of coil embolization, N-butyl-2-cyanoacrylate-based glue, and an Amplatzer Vascular Plug for management of annular rupture with hemodynamic collapse ( 7 , 8 , 9 , 10 ).…”

Prevention and management of peri-procedural TAVR complications

“…In exceptional cases, due to the extreme surgical risk of these patients, percutaneous bail-out measures have been described. The annular tear can be sealed using vascular plugs, embolization coils, implantation of a vascular occlusion device in cases of muscular ventricular septal defect perforations, and less successfully implantation of a second transcatheter heart valve (THV) [39][40][41]42] . In our experience, reversal of heparin can be resolutive when extravasation is limited.…”