Prosthesis Oversizing in Balloon-Expandable Transcatheter Aortic Valve Implantation Is Associated With Contained Rupture of the Aortic Root

Background-To retrospectively investigate the potential cause of contained rupture of the aortic root in balloon-expandable transcatheter aortic valve implantation (TAVI) by means of pre- and postinterventional multislice computed tomography. Methods and Results-Seventy-two patients (mean age 82 +/- 7 years, mean aortic valve area 0.69 +/- 0.19 cm(2)) underwent balloon-expandable TAVI using the EdwardsSAPIEN Transcatheter Heart Valve (23 mm, n=19; 26 mm, n=50; 29 mm, n=3). Aortic annulus dimensions were quantified by multislice computed tomography-based cross-sectional area assessment and average diameter calculation (CAAD) before and after TAVI. Post-TAVI multislice computed tomography data sets were available in 65 patients; contained aortic root rupture was diagnosed in 3 patients. Pre-TAVI CAAD was 23.1 +/- 1.8 mm; post-TAVI CAAD was 22.9 +/- 1.3 mm. Median relative change in CAAD pre- and post-TAVI was -0.5% (interquartile range, 3.6%). Relative increase of 5% to 10% was observed in 4 patients (1 with contained rupture), relative increase >10% in 2 patients, both with contained rupture. Mean relative oversizing, calculated as the relative difference in diameter between pre-TAVI CAAD and nominal diameter of the selected prosthesis, was 9.8%+/- 7.8%. Relative oversizing was significantly higher in patients with contained rupture compared with patients without contained rupture (24.6%+/- 5.4% versus 9.1%+/- 6.6%; P<0.001). Relative oversizing >= 20% occurred in 6 patients (3 with contained rupture). Conclusions-Contained rupture of the aortic root in balloon-expandable TAVI is associated with severe prosthesis oversizing. Multislice computed tomography-based assessment of aortic annulus dimension in conjunction with adapted sizing guidelines may reduce the incidence of severe oversizing. (Circ Cardiovasc Interv. 2012; 5:540-548.)