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Aortic Complex Rupture After Transcatheter Aortic Valve Implantation
Yasuo Tsuru1, Mizuki Miura1, Shinichi Shirai1
1Department of Cardiology, Kokura Memorial Hospital.
International Heart Journal
|April 26, 2019
Summary
Transcatheter aortic valve implantation (TAVI) can cause rare aortic complex rupture, particularly in elderly, small women with calcified aortic annuli. Careful TAVI strategies and prompt heart team management minimize rupture risks and mortality.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Aortic complex rupture is a rare but critical complication of transcatheter aortic valve implantation (TAVI).
- Identifying predictors and optimizing management strategies for aortic complex rupture remain challenging due to its infrequent occurrence and variable mechanisms.
Observation:
- A case series identified aortic complex rupture in 0.8% of patients (4/497).
- All affected patients were elderly women with small, heavily calcified aortic annuli.
- Balloon-expandable valves and aggressive TAVI strategies (oversizing, post-dilatation) were common factors.
Findings:
- No in-hospital mortality was observed in the four cases of aortic complex rupture.
- Two patients were managed conservatively, while two required emergent thoracotomy for surgical hemostasis.
- Key similarities included patient demographics, valve type, aortic annulus characteristics, and treatment intensity.
Implications:
- TAVI in high-risk patients necessitates a meticulous and tailored procedural strategy.
- Prompt recognition and collaborative management by an institutional heart team are vital for minimizing damage from aortic complex rupture.
- Conservative management or emergent surgery can be effective depending on the clinical scenario.
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