Thorac Cardiovasc Surg 2015; 63 - OP98
DOI: 10.1055/s-0035-1544350

Predictive Factors for the Occurence of Annular Ruptures during Transcatheter Aortic Valve Implantation

B. Fujita 1, M. Kütting 2, S. Jategaonkar 3, W. Scholtz 3, J. Gummert 1, S. Ensminger 1
  • 1Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
  • 2Institut für Angewandte Medizintechnik, Helmholtz-Institut der RWTH Aachen und Universitätsklinikum Aachen, Aachen, Germany
  • 3Klinik für Kardiologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany

Objectives: Annulus ruptures are a rare but mostly fatal complication during TAVI. The aim of this study was to identify anatomical, morphological and procedural factors associated with annulus ruptures.

Methods: Preoperative MSCT scans were analyzed for all patients that suffered an annulus rupture (n = 5). Under the assumption that the calcification pattern represents a major risk factor, patients with a similar calcification pattern were identified (n = 7). MSCT images of all patients were analyzed in detail with Mimics® and 3Matic® software specifically designed for detailed MDCT analysis. In addition, patient and procedural characteristics were analyzed and compared in detail.

Results: Patients who suffered perforations received either a Corevalve (n = 4) or an Edwards Sapien (n = 1) and all procedures were performed transfemorally. All patients with annulus perforation presented with a heavy calcified spur extending deeply into the LVOT and displayed a significant degree of eccentricity within the aortic annulus. Interestingly, in all patients with rupture, this spur was positioned at the long axis of the eccentric aortic annulus, whereas in patients who did not suffer an annulus rupture, there was no correlation with the position of the spur. Compared with the control group, in patients with annulus rupture there was also a higher degree of oversizing of implanted valve present.

Conclusions: Our analysis yielded three risk factors that are associated with annular ruptures when present simultaneously. However, for some factors its influence on annulus ruptures is not clear and therefore requires further investigation.