Aortic root volume is associated with contained rupture of the aortic annulus in balloon-expandable transcatheter aortic valve replacement.
BACKGROUND
Aortic annulus rupture is a rare, but potentially fatal complication of transcatheter aortic valve replacement (TAVR), especially when it occurs by balloon-expandable devices. In order to improve the predictability of procedures and avoid ruptures we investigated whether or not the aortic root volume measures is a useful indicator of risk, and if it could be useful for the prosthesis size selection.


RESULTS
From a retrospective series of 172 TAVR patients, seven experienced contained aortic annulus ruptures. The receiver operating curves were used to illustrate sensitivity and specificity of the different aortic annulus size and aortic root volume measures. The annulus area oversizing of ≥20% resulted in a sensitivity of 100%, specificity of 55.76%, and positive predictive value (PPV) of 8.75%. In patients receiving 26 mm prostheses, the aortic root volume (ARV <13600 mm(3)) provided a better specificity and PPV (79.63 and 18.52%, respectively). A two-step testing procedure considering the area derived average annulus diameter (Darea <23 mm) as a first separating parameter and then the ARV (<13,600 mm(3)) as a further indicator showed the most promising results with the PPV of 31.25%. Regardless of the procedure steps no false negative results were predicted.


CONCLUSIONS
Our data show that the ARV provides a better predictive value for correct prosthesis sizing than established annulus measurements, especially in 'borderline' annuli. We suggest a two-step testing procedure for prostheses size selection, considering Darea and ARV to minimize the risk of annulus rupture. Prospective studies and examination of larger datasets are warranted to confirm these findings.
Heart Center Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany.
Jochen
J
Reinöhl
Heart Center Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany.
Dimitrios
D
Psyrakis
Heart Center Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany.|Institute of Medical Biometry and Informatics, Medical Center, University of Freiburg, Freiburg, Germany.
Klaus
K
Kaier
Almazov Federal Heart, Blood and Endocrinology Centre, Saint Petersburg, Russia.|Morehouse School of Medicine, Neuroscience Institute, Atlanta, Georgia, USA.
Sodikdjon
S
Kodirov
Heart Center Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany.
Matthias
M
Siepe
Heart Center Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany.
Anja
A
Gutmann
Heart Center Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany.
Constantin
C
von zur Mühlen
Heart Center Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany.
Martin
M
Moser
Heart Center Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany.
Ingo
I
Ahrens
Department of Radiology, Center for Diagnostic and Therapeutic Radiology, University Hospital Freiburg, Germany.
Gregor
G
Pache
Heart Center Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany.
Andreas
A
Zirlik
Department of Radiology, Center for Diagnostic and Therapeutic Radiology, University Hospital Freiburg, Germany.
Mathias
M
Langer
Heart Center Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany.
Friedhelm
F
Beyersdorf
Heart Center Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany.
Manfred
M
Zehender
Heart Center Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany.
Christoph
C
Bode
Department of Radiology, Center for Diagnostic and Therapeutic Radiology, University Hospital Freiburg, Germany.
Philipp
P
Blanke
D000368:Aged; D000369:Aged, 80 and over; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D001021:Aortic Valve / Q000000981:diagnostic imaging*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D001027:Aortography / Q000379:methods*; D063126:Balloon Valvuloplasty / Q000009:adverse effects*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D000072226:Computed Tomography Angiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
aortic annulus rupture; aortic root volumetry; contained aortic root rupture; transcatheter aortic valve replacement