title: Prosthesis oversizing in balloon-expandable transcatheter aortic valve implantation is associated with contained rupture of the aortic root.
abstract: BACKGROUND
  To retrospectively investigate the potential cause of contained rupture of the aortic root in balloon-expandable transcatheter aortic valve implantation (TAVI) by means of pre- and postinterventional multislice computed tomography.
  
  
  RESULTS
  Seventy-two patients (mean age 82±7 years, mean aortic valve area 0.69±0.19 cm(2)) underwent balloon-expandable TAVI using the EdwardsSAPIEN Transcatheter Heart Valve (23 mm, n=19; 26 mm, n=50; 29 mm, n=3). Aortic annulus dimensions were quantified by multislice computed tomography-based cross-sectional area assessment and average diameter calculation (CAAD) before and after TAVI. Post-TAVI multislice computed tomography data sets were available in 65 patients; contained aortic root rupture was diagnosed in 3 patients. Pre-TAVI CAAD was 23.1±1.8 mm; post-TAVI CAAD was 22.9±1.3 mm. Median relative change in CAAD pre- and post-TAVI was -0.5% (interquartile range, 3.6%). Relative increase of 5% to 10% was observed in 4 patients (1 with contained rupture), relative increase >10% in 2 patients, both with contained rupture. Mean relative oversizing, calculated as the relative difference in diameter between pre-TAVI CAAD and nominal diameter of the selected prosthesis, was 9.8%±7.8%. Relative oversizing was significantly higher in patients with contained rupture compared with patients without contained rupture (24.6%±5.4% versus 9.1%±6.6%; P<0.001). Relative oversizing ≥20% occurred in 6 patients (3 with contained rupture).
  
  
  CONCLUSIONS
  Contained rupture of the aortic root in balloon-expandable TAVI is associated with severe prosthesis oversizing. Multislice computed tomography-based assessment of aortic annulus dimension in conjunction with adapted sizing guidelines may reduce the incidence of severe oversizing.
authors.affiliation: Department of Diagnostic Radiology, University Hospital Freiburg, Hugstetter Strasse 55, Freiburg, Germany. philipp.blanke@uniklinik-freiburg.de
authors.forename: Philipp
authors.initials: P
authors.lastname: Blanke
authors.forename: Jochen
authors.initials: J
authors.lastname: Reinöhl
authors.forename: Christian
authors.initials: C
authors.lastname: Schlensak
authors.forename: Matthias
authors.initials: M
authors.lastname: Siepe
authors.forename: Gregor
authors.initials: G
authors.lastname: Pache
authors.forename: Wulf
authors.initials: W
authors.lastname: Euringer
authors.forename: Annette
authors.initials: A
authors.lastname: Geibel-Zehender
authors.forename: Christopher
authors.initials: C
authors.lastname: Bode
authors.forename: Mathias
authors.initials: M
authors.lastname: Langer
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Beyersdorf
authors.forename: Manfred
authors.initials: M
authors.lastname: Zehender
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology; D001013:Aorta, Thoracic / Q000293:injuries*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008955:Models, Cardiovascular; D009929:Organ Size; D011474:Prosthesis Design; D012189:Retrospective Studies; D012421:Rupture; D014057:Tomography, X-Ray Computed