Anatomical and Procedural Features Associated With Aortic Root Rupture During Balloon-Expandable Transcatheter Aortic Valve Replacement

作者：Barbanti, Marco; Yang, Tae-Hyun; Cabau, Josep Rodes; Tamburino, Corrado; Wood, David A.; Jilaihawi, Hasan; Blanke, Phillip; Makkar, Raj R.; Latib, Azeem; Colombo, Antonio; Tarantini, Giuseppe; Raju, Rekha; Binder, Ronald K.; Nguyen, Giang; Freeman, Melanie; Ribeiro, Henrique B.; Kapadia, Samir; Min, James; Feuchtner, Gudrun; Gurtvich, Ronen; Alqoofi, Faisal; Pelletier, Marc; Ussia, Gian Paolo; Napodano, Massimo; de Brito, Fabio Sandoli; Kodali, Susheel; Norgaard, Bjarne L.; Hansson, Nicolaj C.

来源：Circulation, 2013, 128(3): 244-253.

DOI：10.1161/CIRCULATIONAHA.113.002947

• annular calcification
• annular rupture
• multidetector computed tomography
• transcatheter heart valves

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. @@@ Methods and 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.

• 出版日期2013-7-16