+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Aortic root volume is associated with contained rupture of the aortic annulus in balloon-expandable transcatheter aortic valve replacement

Aortic root volume is associated with contained rupture of the aortic annulus in balloon-expandable transcatheter aortic valve replacement

Catheterization and Cardiovascular Interventions 87(4): 807-817

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. 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. 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.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 057218627

Download citation: RISBibTeXText

PMID: 26501403

DOI: 10.1002/ccd.26260

Related references

Prosthesis oversizing in balloon-expandable transcatheter aortic valve implantation is associated with contained rupture of the aortic root. Circulation. Cardiovascular Interventions 5(4): 540-548, 2012

Early Hemodynamic Results In Patients With Small Aortic Annulus Undergoing Surgical Sutureless Aortic Valve Replacement (Perceval) And Balloon-Expandable Transcatheter Aortic Valve Implantation. Canadian Journal of Cardiology 32(10): S305-S306, 2016

Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement. Circulation 128(3): 244-253, 2013

Outcomes in patients with contained ruptures of the aortic annulus after transcatheter aortic valve implantation with balloon-expandable devices. Eurointervention 13(11): 1300-1302, 2017

The impact of calcium volume and distribution in aortic root injury related to balloon-expandable transcatheter aortic valve replacement. Journal of Cardiovascular Computed Tomography 9(5): 382-392, 2016

Aortic annulus rupture during transcatheter aortic valve implantation: safe aortic root replacement. EuropeanJournalofCardio-ThoracicSurgery41(5):1205, 2012

Balloon expandable transcatheter heart valve eccentricity in the non-calcified aortic annulus - should the aortic annulus stiffness come on stage?. Kardiologia Polska 75(1): 81, 2017

An autopsy case of aortic root rupture with thin porcelain aorta during balloon-expandable transcatheter aortic valve implantation. Journal of Cardiology Cases 16(6): 186-188, 2017

1-Year Follow-Up of Contained Aortic Root Rupture After Transcatheter Aortic Valve Replacement. Jacc. Cardiovascular Interventions 9(3): 295-296, 2016

Successful Transcatheter Aortic Valve Replacement Using Balloon-Expandable Valve for Pure Native Aortic Valve Regurgitation in the Presence of Ascending Aortic Dissection. Journal of Invasive Cardiology 30(7): E62-E63, 2018

Aortic annulus eccentricity before and after transcatheter aortic valve implantation: comparison of balloon-expandable and self-expandable prostheses. European Heart Journal 34(Suppl 1): P271-P271, 2013

Prognostic value of aortic root calcification volume on clinical outcomes after transcatheter balloon-expandable aortic valve implantation. Catheterization and Cardiovascular Interventions 86(6): 1105-1113, 2015

Use of balloon aortic valvuloplasty to size the aortic annulus before implantation of a balloon-expandable transcatheter heart valve. Jacc. Cardiovascular Interventions 3(1): 114-118, 2010

Aortic annulus and root characteristics in severe aortic stenosis due to bicuspid aortic valve and tricuspid aortic valves: implications for transcatheter aortic valve therapies. Catheterization and Cardiovascular Interventions 86(2): E88-E98, 2015

Aortic annulus eccentricity before and after transcatheter aortic valve implantation: Comparison of balloon-expandable and self-expanding prostheses. European Journal of Radiology 84(7): 1242-1248, 2015