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Three-step surgical management algorithm for annular rupture in transcatheter aortic valve replacement
Kizuku Yamashita1, Kazuo Shimamura1, Koichi Maeda2
1Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
JTCVS Techniques
|December 28, 2023
Summary
A novel 3-step algorithm effectively treated transcatheter aortic valve replacement annular rupture, a rare but serious complication. This approach led to survival in 6 high-risk patients, demonstrating its feasibility and effectiveness in managing this critical event.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Transcatheter aortic valve replacement (TAVR) is a common procedure.
- Annular rupture is a rare but life-threatening complication of TAVR.
- Optimal management strategies for annular rupture remain undefined due to its low incidence.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of a novel three-step algorithm for managing annular rupture during transcatheter aortic valve implantation (TAVI).
Main Methods:
- A retrospective analysis of 8 patients who experienced annular rupture during TAVI between 2009 and 2022.
- Patients were treated using a three-step algorithm: 1) pericardial drainage, protamine neutralization, and blood pressure control; 2) manual hemostatic compression via sternotomy; 3) conservative treatment or surgical correction.
- The algorithm's success in achieving hemostasis and patient survival was assessed.
Main Results:
- Annular rupture occurred in 0.8% of TAVI procedures (8 out of 1083 patients).
- All 8 patients underwent the first step (pericardial drainage); 5 achieved hemostasis. Two patients required the second step, and one needed the third step.
- Six patients (75%) survived and were discharged without major complications; two patients died during hospitalization.
Conclusions:
- The three-step algorithm is a feasible and effective strategy for managing annular rupture following TAVI.
- This algorithm offers a potential treatment pathway for high-risk or inoperable patients experiencing this complication.
- Successful management of annular rupture can lead to improved survival rates in complex patient populations.
