title: Annular rupture during transcatheter aortic valve replacement: classification, pathophysiology, diagnostics, treatment approaches, and prevention.
abstract: Annular rupture is an umbrella term covering different procedural-related injuries that may occur in the region of the aortic root and the left ventricular outflow tract during transcatheter aortic valve replacement. According to the anatomical location of the injury, there are 4 main types: supra-annular, intra-annular, subannular, and combined rupture. Annular rupture is a rare, unpredictable, and potentially fatal complication. It can be treated successfully if it is immediately recognized and adequately managed. The type of therapy depends on the location of the annular rupture and the nature of the clinical manifestations. Treatment approaches include conventional cardiac procedure, isolated pericardial drainage, and conservative therapy. This summary describes theoretical and practical considerations of the etiology, pathophysiology, classification, natural history, diagnostic and treatment strategies, and prevention approaches of annular rupture.
authors.affiliation: Deutsches Herzzentrum Berlin, Berlin, Germany. Electronic address: pasic@dhzb.de.
authors.forename: Miralem
authors.initials: M
authors.lastname: Pasic
authors.affiliation: Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Unbehaun
authors.affiliation: Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Semih
authors.initials: S
authors.lastname: Buz
authors.affiliation: Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Drews
authors.affiliation: Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D001021:Aortic Valve / Q000293:injuries* / Q000503:physiopathology; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D003952:Diagnostic Imaging / Q000379:methods; D006335:Heart Injuries / Q000145:classification / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006801:Humans; D015994:Incidence; D011237:Predictive Value of Tests; D016896:Treatment Outcome
keywords: TAVR; annular rupture; annulus rupture; aortic root rupture; complications; device landing zone