title: Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement.
abstract: 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.
  
  
  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 cross-sectional 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 (181.2±211.0 versus 22.5±37.6, P<0.001), and a higher frequency of ≥20% annular area oversizing (79.4% versus 29.0%, P<0.001) and balloon postdilatation (22.6% versus 0.0%, P=0.005). In conditional logistic regression analysis for the matched data, moderate/severe LVOT/subannular calcifications (odds ratio, 10.92; 95% confidence interval, 3.23-36.91; P<0.001) and prosthesis oversizing ≥20% (odds ratio, 8.38; 95% confidence interval, 2.67-26.33; P<0.001) were associated with aortic root contained/noncontained rupture.
  
  
  CONCLUSIONS
  This study demonstrates that LVOT calcification and aggressive annular area oversizing are associated with an increased risk of aortic root rupture during TAVR with balloon-expandable prostheses. Larger studies are warranted to confirm these findings.
authors.affiliation: St Paul’s Hospital, Vancouver, BC, Canada.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.forename: Tae-Hyun
authors.initials: TH
authors.lastname: Yang
authors.forename: Josep
authors.initials: J
authors.lastname: Rodès Cabau
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: David A
authors.initials: DA
authors.lastname: Wood
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.forename: Phillip
authors.initials: P
authors.lastname: Blanke
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.forename: Rekha
authors.initials: R
authors.lastname: Raju
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Binder
authors.forename: Giang
authors.initials: G
authors.lastname: Nguyen
authors.forename: Melanie
authors.initials: M
authors.lastname: Freeman
authors.forename: Henrique B
authors.initials: HB
authors.lastname: Ribeiro
authors.forename: Samir
authors.initials: S
authors.lastname: Kapadia
authors.forename: James
authors.initials: J
authors.lastname: Min
authors.forename: Gudrun
authors.initials: G
authors.lastname: Feuchtner
authors.forename: Ronen
authors.initials: R
authors.lastname: Gurtvich
authors.forename: Faisal
authors.initials: F
authors.lastname: Alqoofi
authors.forename: Marc
authors.initials: M
authors.lastname: Pelletier
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Ussia
authors.forename: Massimo
authors.initials: M
authors.lastname: Napodano
authors.forename: Fabio Sandoli
authors.initials: FS
authors.lastname: de Brito
authors.forename: Susheel
authors.initials: S
authors.lastname: Kodali
authors.forename: Bjarne L
authors.initials: BL
authors.lastname: Norgaard
authors.forename: Nicolaj C
authors.initials: NC
authors.lastname: Hansson
authors.forename: Gregor
authors.initials: G
authors.lastname: Pache
authors.forename: Sergio J
authors.initials: SJ
authors.lastname: Canovas
authors.forename: Hongbin
authors.initials: H
authors.lastname: Zhang
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D001021:Aortic Valve / Q000000981:diagnostic imaging; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D006328:Cardiac Catheterization; D015331:Cohort Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: annular calcification; annular rupture; multidetector computed tomography; transcatheter heart valves