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

  • Paul 's Hospital S
  • Vancouver C
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244 T ranscatheter aortic valve replacement (TAVR) is now considered an effective treatment for patients with severe aortic stenosis at high risk for conventional surgical aortic valve replacement. 1,2 Although TAVR has been shown to be an effective therapy, limitations do remain. Recently, 3-dimensional multidetector computed tomography (MDCT) measurements have been shown to provide a deeper under-standing of aortic annular geometry and allow for prediction 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

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  • St Paul 's Hospital

  • Canada Vancouver

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