Prosthesis-oversizing in balloon-expandable transcatheter aortic valve implantation is associated with contained rupture of the aortic root

Abstract

Ziele: 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 post-interventional multi-slice computed tomography (MSCT). Methode: Seventy-two patients (mean age 82±7 years, mean aortic valve area 0.69±0.19cm2) underwent balloon-expandable TAVI using the EdwardsSAPIEN Transcatheter Heart Valve (23mm, n=19; 26mm, n=50; 29mm n=3). Aortic annulus dimensions were quantified by MSCT-based cross-sectional area assessment and average diameter calculation (CAAD) prior and after TAVI. Post-TAVI MSCT data sets were available in 65 patients. Ergebnis: Contained aortic root rupture was diagnosed in 3 patients. Pre-TAVI CAAD was 23.1±1.8mm; post-TAVI CAAD was 22.9±1.3mm. Median relative change in CAAD pre- and post-TAVI was -0.5% (IQR 3.6%). Relative increase of 5–10% was observed in 4 patients (1 with contained rupture), relative increase >10% in two patients, both with contained rupture. Median relative oversizing, calculated as the relative difference in diameter between pre-TAVI CAAD and nominal diameter of the selected prosthesis was 8.4% (IQR 9.2%). Relative oversizing ≥20% occurred in 6 patients due to selection of a 26mm prosthesis by means of TEE in the setting of a MSCT-based CAAD <22mm (n=5) or small annulus anatomy although choosing the smallest prosthesis currently available (n=1), and was significantly associated with contained rupture (n=3; p=0.0005, Fisher's Exact test). Schlussfolgerung: Relative oversizing >20% in balloon-expandable TAVI is significantly associated with contained rupture of the aortic root. MSCT-based assessment of aortic annulus dimension in conjunction with adapted sizing-guidelines may reduce the incidence of severe oversizing.