title: Rupture of the device landing zone during transcatheter aortic valve implantation: a life-threatening but treatable complication.
abstract: 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.
  
  
  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.
authors.affiliation: Deutsches Herzzentrum Berlin, Berlin, Germany. pasic@dhzb.de
authors.forename: Miralem
authors.initials: M
authors.lastname: Pasic
authors.forename: Axel
authors.initials: A
authors.lastname: Unbehaun
authors.forename: Stephan
authors.initials: S
authors.lastname: Dreysse
authors.forename: Semih
authors.initials: S
authors.lastname: Buz
authors.forename: Thorsten
authors.initials: T
authors.lastname: Drews
authors.forename: Marian
authors.initials: M
authors.lastname: Kukucka
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Ancona
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000369:Aged, 80 and over; D001011:Aorta / Q000293:injuries; D001021:Aortic Valve / Q000293:injuries; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D005260:Female; D005858:Germany; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D011474:Prosthesis Design; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome