Perforation of the descending thoracic aorta during transcatheter aortic valve implantation (TAVI): An unexpected and dramatic procedural complication

Aminian, Adel; Lalmand, Jacques; Nakadi, Badih El

doi:10.1002/ccd.22960

Cited by 31 publications

(25 citation statements)

References 8 publications

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“…[1][2][3][4][5][6][7] Different iatrogenic damages may take place at various levels of the aortic root [5][6][7] in the so-called "the device landing zone." 8 In contrast to a standard surgical procedure, if the complications do occur, they are very difficult to control.…”

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confidence: 99%

Rupture of the Device Landing Zone During Transcatheter Aortic Valve Implantation

Pašić

Unbehaun

Dreysse

et al. 2012

Circ: Cardiovascular Interventions

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Background— Iatrogenic damage of different structures of the aortic root, in the region of the so-called “device landing zone,” may occur during transcatheter aortic valve implantation (TAVI). It is mostly considered difficult to treat or even untreatable. Methods and Results— We performed a retrospective analysis of the occurrence, clinical presentation, treatment, and outcome of iatrogenic rupture in the device landing zone in a series of 618 consecutive patients who underwent TAVI at our institution between April 2008 and October 2011. The incidence of rupture was 1% (6 patients). The correct diagnosis was established during TAVI procedures in 4 and postmortem in 2 patients. The major sign of the aortic rupture was apparent bleeding in 4 patients and failure of myocardial recovery after valve implantation in 1; it was asymptomatic in 1 patient. The iatrogenic rupture in the region of the device landing zone was treated surgically in 5 patients and only conservatively in the patient without symptoms. When the diagnosis was established correctly during TAVI, only 1 of 4 patients died (25%). The overall mortality rate was 50% (3 of 6 patients died). Conclusions— Rupture of different structures in the device landing zone during TAVI is a life-threatening complication that can be treated successfully if it is immediately recognized and adequately managed.

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confidence: 99%

Rupture of the Device Landing Zone During Transcatheter Aortic Valve Implantation

Pašić

Unbehaun

Dreysse

et al. 2012

Circ: Cardiovascular Interventions

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“…Aortic valve area was 0.5 cm 2 , mean gradient was 86 mm Hg, and left ventricular ejection fraction was 64% on transthoracic echocardiography. Aortic annulus sizing was 23.5 and 23.7 mm by transesophageal echocardiography and multidetector computed tomography, respectively.…”

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confidence: 98%

“…Acute rupture of the descending aorta is unusual and almost invariably has a lethal outcome. 2,3 This complication should be suspected in the case of unexplained hypotension during catheter advancement. In our case, we hypothesize that the aortic rupture at the time the delivery system was advanced was attributable to the presence of an acute angle in the aortic arch that transmitted resistance to the delivery system and kinked the descending aorta in the proximal angle.…”

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confidence: 99%

Descending Aorta Rupture During Transcatheter Aortic Valve Replacement

et al. 2016

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“…• bad controllability of catheter; limited bandwidth due to slack, friction, and catheter compliance; • little control over interaction, possibly causing dislodgement of plaque or calcium, tissue damage or rupture; 19,20 • lengthy procedure involving many preparatory steps including the introduction of a guidewire, of a catheter to dilate the native valve, of a stabilizing sheet and so on; • safety issues arise as the surgeon is working in a nonergonomic manner under high mental and physical load.…”

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confidence: 99%

Cognitive AutonomouS CAtheters Operating in Dynamic Environments

Poorten

Tran

Devreker

et al. 2016

J. Med. Robot. Res.

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Advances in miniaturized surgical instrumentation are key to less demanding and safer medical interventions. In cardiovascular procedures interventionalists turn towards catheter-based interventions, treating patients considered unfit for more invasive approaches. A positive outcome is not guaranteed. The risk for calcium dislodgement, tissue damage or even vessel rupture cannot be eliminated when instruments are maneuvered through fragile and diseased vessels. This paper reports on the progress made in terms of catheter design, vessel reconstruction, catheter shape modeling, surgical skill analysis, decision-making and control. These efforts are geared towards the development of the necessary technology to autonomously steer catheters through the vasculature, a target of the EU-funded project CASCADE (Cognitive AutonomouS CAtheters operating in Dynamic Environments). Whereas autonomous placement of an aortic valve implant forms the ultimate and concrete goal, the technology of individual building blocks to reach such ambitious goal is expected to be much sooner impacting and assisting interventionalists in their daily clinical practice.

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Perforation of the descending thoracic aorta during transcatheter aortic valve implantation (TAVI): An unexpected and dramatic procedural complication

Cited by 31 publications

References 8 publications

Rupture of the Device Landing Zone During Transcatheter Aortic Valve Implantation

Rupture of the Device Landing Zone During Transcatheter Aortic Valve Implantation

Descending Aorta Rupture During Transcatheter Aortic Valve Replacement

Cognitive AutonomouS CAtheters Operating in Dynamic Environments

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