Potential mechanism of annulus rupture during transcatheter aortic valve implantation

Hayashida, Kentaro; Bouvier, Erik; Lefèvre, Thierry; Hovasse, Thomas; Morice, Marie Claude; Chevalier, Bernard; Romano, Mauro; Garot, Philippe; Farge, Arnaud; Donzeau–Gouge, Patrick; Cormier, Bertrand

doi:10.1002/ccd.24524

Cited by 78 publications

(51 citation statements)

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“…Recently, Hayashida et al showed that significant calcification located in a vulnerable area as revealed by MDCT might be a possible mechanism for annular rupture in 2 cases of balloon-expandable TAVR. 17 Some have suggested that the location of LVOT calcification might also increase the risk of annular rupture. Theoretically, trigonal calcification may impart greater rigidity to the annulus and make it prone to rupture, whereas more anterior calcification may not impart as great of a risk.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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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 crosssectional 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 (

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Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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“…This is particularly the case for the inflow portion of the valve as this is the site where most of the complications occur, for example paravalvular regurgitation and bundle branch block and also the rare but dramatic event of coronary obstruction [7][8][9][10][11][12][13] . Most likely, the overestimation unveils limitations of the software.…”

Section: Discussionmentioning

confidence: 99%

“…With respect to the latter, one might cite as examples incomplete and/or non-circular frame expansion due to the presence of aortic root calcifications leading to paravalvular regurgitation, unexpected mobilisation of calcified leaflets leading to coronary obstruction, and dissection or rupture of the aortic root even in the presence of appropriate valve size selection [7][8][9][10][11][12][13] . Device-host interactions are clinically difficult to predict because of the large variations in the geometry and dimensions of the aortic root in addition to the variations in the amount and distribution of calcium between patients.…”

Section: Introductionmentioning

confidence: 99%

Patient-specific image-based computer simulation for theprediction of valve morphology and calcium displacement after TAVI with the Medtronic CoreValve and the Edwards SAPIEN valve

Schultz¹,

Rodríguez-Olivares²,

Bosmans³

et al. 2016

EuroIntervention

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Aims: Our aim was to validate patient-specific software integrating baseline anatomy and biomechanical properties of both the aortic root and valve for the prediction of valve morphology and aortic leaflet calcium displacement after TAVI.Methods and results: Finite element computer modelling was performed in 39 patients treated with a Medtronic CoreValve System (MCS; n=33) or an Edwards SAPIEN XT (ESV; n=6). Quantitative axial frame morphology at inflow (MCS, ESV) and nadir, coaptation and commissures (MCS) was compared between multislice computed tomography (MSCT) post TAVI and a computer model as well as displacement of the aortic leaflet calcifications, quantified by the distance between the coronary ostium and the closest calcium nodule. Bland-Altman analysis revealed a strong correlation between the observed (MSCT) and predicted frame dimensions, although small differences were detected for, e.g., Dmin at the inflow (mean±SD MSCT vs. model: 21.6±2.4 mm vs. 22.0±2.4 mm; difference±SD: -0.4±1.3 mm, p<0.05) and Dmax (25.6±2.7 mm vs. 26.2±2.7 mm; difference±SD: -0.6±1.0 mm, p<0.01). The observed and predicted calcium displacements were highly correlated for the left and right coronary ostia (R 2 =0.67 and R 2 =0.71, respectively p<0.001).Conclusions: Dedicated software allows accurate prediction of frame morphology and calcium displacement after valve implantation, which may help to improve outcome. KEYWORDS• aortic stenosis • computer modelling • transcatheter aortic valve implantation (TAVI)

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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%

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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Potential mechanism of annulus rupture during transcatheter aortic valve implantation

Cited by 78 publications

References 3 publications

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

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

Patient-specific image-based computer simulation for theprediction of valve morphology and calcium displacement after TAVI with the Medtronic CoreValve and the Edwards SAPIEN valve

Transcatheter aortic valve replacement with balloon-expandable valve

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