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

被引：435

作者：

Barbanti, Marco ^{[1
,2
]}

Yang, Tae-Hyun ^{[1
,3
]}

Cabau, Josep Rodes ^{[4
]}

Tamburino, Corrado ^{[2
]}

Wood, David A. ^{[1
]}

Jilaihawi, Hasan ^{[5
]}

Blanke, Phillip ^{[6
]}

Makkar, Raj R. ^{[5
]}

Latib, Azeem ^{[7
,8
]}

Colombo, Antonio ^{[7
,8
]}

Tarantini, Giuseppe ^{[9
]}

Raju, Rekha ^{[1
]}

Binder, Ronald K. ^{[1
]}

Nguyen, Giang ^{[1
]}

Freeman, Melanie ^{[1
]}

Ribeiro, Henrique B. ^{[4
]}

Kapadia, Samir ^{[17
]}

Min, James ^{[4
]}

Feuchtner, Gudrun ^{[11
]}

Gurtvich, Ronen ^{[12
]}

Alqoofi, Faisal ^{[13
]}

Pelletier, Marc ^{[14
]}

Ussia, Gian Paolo ^{[15
]}

Napodano, Massimo ^{[7
,8
]}

de Brito, Fabio Sandoli ^{[16
]}

Kodali, Susheel ^{[10
]}

Norgaard, Bjarne L. ^{[18
]}

Hansson, Nicolaj C. ^{[18
]}

Pache, Gregor ^{[6
]}

Canovas, Sergio J. ^{[19
]}

Zhang, Hongbin ^{[1
]}

Leon, Martin B. ^{[17
]}

Webb, John G. ^{[1
]}

Leipsic, Jonathon ^{[1
]}

机构：

[1] St Pauls Hosp, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada

[2] Univ Catania, Ferrarotto Hosp, Catania, Italy

[3] Inje Univ, Busan Paik Hosp, Busan, South Korea

[4] Laval Univ, Quebec Heart & Lung Inst, Quebec City, PQ, Canada

[5] Cedars Sinai Heart Inst, Los Angeles, CA USA

[6] Univ Hosp Freiburg, Freiburg, Germany

[7] EMO GVM Ctr Cuore Columbus, Milan, Italy

[8] Ist Sci San Raffaele, Milan, Italy

[9] Univ Padua, Padua, Italy

[10] Cleveland Clin, Cleveland, OH 44106 USA

[11] Innsbruck Med Univ, A-6020 Innsbruck, Austria

[12] Royal Melbourne Hosp, Melbourne, Vic, Australia

[13] Univ Calgary, Calgary, AB, Canada

[14] New Brunswick Heart Ctr, St John, NB, Canada

[15] Univ Roma Tor Vergata, Dept Cardiovasc Dis, Rome, Italy

[16] Hosp Israelita Albert Einstein Sao Paulo, Sao Paulo, Brazil

[17] Columbia Univ, Med Ctr, New York Presbyterian Hosp, New York, NY USA

[18] Aarhus Univ, Skejby Hosp, Aarhus, Denmark

[19] Univ Gen Hosp Valencia, Valencia, Spain

来源：

CIRCULATION | 2013年 / 128卷 / 03期

关键词：

annular calcification; annular rupture; multidetector computed tomography; transcatheter heart valves; MULTIDETECTOR COMPUTED-TOMOGRAPHY; IMPLANTATION; REGURGITATION; MANAGEMENT; OUTCOMES; ANNULUS;

D O I：

10.1161/CIRCULATIONAHA.113.002947

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

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.

引用

页码：244 / 253

页数：10

共 20 条

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