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Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement

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barbanti-et-al-2013-anatomical-and-procedural-features-associated-with-aortic-root-rupture-during-balloon-expandable.pdf(319.94 KB)
Date
2013-06-07
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Authors
Barbanti, Marco ; Yang, Tae-Hyun ; Rodès Cabau, Josep ; Tamburino, Corrado ; Wood, David A. ; Jilaihawi, Hasan ; Blanke, Philips ; 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 ; Sandoli de Brito, Fabio ; Kodali, Susheel ; Norgaard, Bjarne L. ; Hansson, Nicolaj C. ; Pache, Gregor ; Canovas López, Sergio ; Zhang, Hongbin ; Leon, Martin B. ; Webb, John G. ; Leipsic, Jonathon
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Publisher
Lippincott, Williams & Wilkins
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Cirugía, Pediatría y Obstetricia y Ginecología
Description
© 2013 American Heart Association, Inc. This document is the Published Manuscript, version of a Published Work that appeared in final form in Circulation. To access the final edited and published work see https://doi.org/10.1161/CIRCULATIONAHA.113.002947
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. 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.
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Annular calcification , Annular rupture , Multidetector computed tomography , Transcatheter heart valves
Citation
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http://hdl.handle.net/10201/151081
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