Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Barbanti Marco, Yang Tae-Hyun, Rodès Cabau Josep, Tamburino Corrado, Wood David A, Jilaihawi Hasan, Blanke Phillip, 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, de Brito Fabio Sandoli, Kodali Susheel, Norgaard Bjarne L, Hansson Nicolaj C, Pache Gregor, Canovas Sergio J, Zhang Hongbin, Leon Martin B, Webb John G, Leipsic Jonathon
Аннотация
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.