Skip to main content
SpringerLink
Log in

Ruptures of the device landing zone in patients undergoing transcatheter aortic valve implantation: an analysis of TAVI Karlsruhe (TAVIK) patients

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Background

Aortic rupture of the device landing zone is a rare complication of transcatheter aortic valve implantation (TAVI) and it is associated with significant mortality.

Methods

This study reports on the experience of a single-center in a case series of more than 1,000 implants. We explored patient and procedural characteristics aiming at identifying variables that increase the risk for aortic root rupture.

Results

Among a total of 1,000 TAVI procedures, six patients (0.6 %) had a rupture of the device landing zone. Five of these patients received the balloon-expandable Edwards SAPIEN valve (5/813; 0.62 %) of which four had a supraannular and one a subannular rupture. One patient received the self-expanding Medtronic CoreValve (1/199; 0.5 %; p = n.s. vs. SAPIEN) and had an annular rupture. Factors that were associated with aortic rupture were: (1) the relative size of the valve compared with the aortic annulus and its geometric form; (2) the need for post-dilation of the new valve because of paravalvular leakage; and (3) the location and severity of calcification. We determined, to avoid aortic rupture, caution may be necessary in the presence of the following conditions: (1) flat sinuses of Valsalva and severe calcifications of either the body or the free edge of the aortic cusps (supraannular rupture); (2) an ellipsoid annulus and bulky calcifications on either the base of the cusps or the rim of the annulus (annular rupture); and (3) a narrow left-ventricular outflow tract (LVOT) and bulky calcification of the LVOT (subannular rupture). After considering these precautions, we observed no case of aortic root rupture in the following 600 cases.

Conclusion

The data indicate that to reduce the frequency of aortic rupture, a careful pre-procedural planning appears essential to avoid this serious and potentially deleterious complication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Aminian A, Lalmand J, Dolatabadi D (2013) Late contained aortic root rupture and ventricular septal defect after transcatheter aortic valve implantation. Catheter Cardiovasc Interv 81:E72–E75

    Article  PubMed  Google Scholar 

  2. Pasic M, Buz S, Dreysse S, Drews T, Unbehaun A, Klein C, Kukucka M, Mladenow A et al (2010) Transapical aortic valve implantation in 194 patients: problems, complications, and solutions. Ann Thorac Surg 90:1463–1469 discussion 1469-70

    Article  PubMed  Google Scholar 

  3. Pasic M, Unbehaun A, Dreysse S, Buz S, Drews T, Kukucka M, D’Ancona G, Seifert B et al (2012) Rupture of the device landing zone during transcatheter aortic valve implantation: a life-threatening but treatable complication. Circ Cardiovasc Interv 5:424–432

    Article  PubMed  Google Scholar 

  4. Hayashida K, Bouvier E, Lefevre T, Hovasse T, Morice MC, Chevalier B, Romano M, Garot P et al (2012) Potential mechanism of annulus rupture during transcatheter aortic valve implantation. Catheter Cardiovasc Interv 82(5):E742–E746

    Article  Google Scholar 

  5. Hayashida K, Bouvier E, Lefevre T, Hovasse T, Morice MC, Chevalier B, Romano M, Garot P et al (2012) Impact of CT-guided valve sizing on post-procedural aortic regurgitation in transcatheter aortic valve implantation. Euro Interv 8:546–555

    Google Scholar 

  6. Nielsen HH, Klaaborg KE, Nissen H, Terp K, Mortensen PE, Kjeldsen BJ, Jakobsen CJ, Andersen HR et al (2012) A prospective, randomised trial of transapical transcatheter aortic valve implantation vs. surgical aortic valve replacement in operable elderly patients with aortic stenosis: the STACCATO trial. Euro Interv 8:383–389

    Google Scholar 

  7. Genereux P, Head SJ, Van Mieghem NM, Kodali S, Kirtane AJ, Xu K, Smith C, Serruys PW et al (2012) Clinical outcomes after transcatheter aortic valve replacement using valve academic research consortium definitions: a weighted meta-analysis of 3,519 patients from 16 studies. J Am Coll Cardiol 59:2317–2326

    Article  PubMed  Google Scholar 

  8. Eggebrecht H, Schmermund A, Kahlert P, Erbel R, Voigtlander T, Mehta RH (2013) Emergent cardiac surgery during transcatheter aortic valve implantation (TAVI): a weighted meta-analysis of 9,251 patients from 46 studies. EuroIntervention 8:1072–1080

    Article  PubMed  Google Scholar 

  9. Hayashida K, Bouvier E, Lefevre T (2013) Successful management of annulus rupture in transcatheter aortic valve implantation. JACC Cardiovasc Interv 6:90–91

    Article  PubMed  Google Scholar 

  10. Debonnaire P, Van Herck PL, Katsanos S, van der Kley F, de Weger A, Palmen M, Marsan NA, Schalij MJ et al (2013) How should I treat acute aortic annulus rupture during transcatheter aortic valve implantation? Euro Interv 8:1103–1109

    Google Scholar 

  11. Yu Y, Vallely M, Ng MK (2013) Valve-in-valve implantation for aortic annular rupture complicating transcatheter aortic valve replacement (TAVR). J Invasive Cardiol 25:409–410

    PubMed  Google Scholar 

  12. Subban V, Incani A, Clarke A, Aroney C, Scalia GM, Crowhurst JA, Raffel OC, Walters DL (2013) Conservative management and resolution of a contained rupture of aortic annulus following transcatheter valve replacement. JACC Cardiovasc Interv 6:e33–e34

    Article  PubMed  Google Scholar 

  13. Egenrieder S, Hill S, Backes M, Vohringer M, Sechtem U (2014) Contained aortic annulus rupture with persisting false aneurysm after transfemoral transcatheter aortic valve implantation. Clin Res Cardiol [Epub ahead of print]

  14. O’Sullivan CJ, Stortecky S, Buellesfeld L, Wenaweser P, Windecker S (2014) Preinterventional screening of the TAVI patient: how to choose the suitable patient and the best procedure. Clin Res Cardiol 103:259–274

    Article  PubMed  Google Scholar 

  15. Puls M, Viel T, Danner BC, Jacobshagen C, Teucher N, Hanekop G, Schondube F, Hasenfuss G et al (2012) The risk-to-benefit ratio of transcatheter aortic valve implantation in specific patient cohorts: a single-centre experience. Clin Res Cardiol 101:553–563

    Article  PubMed  PubMed Central  Google Scholar 

  16. Schymik G, Schrofel H, Schymik JS, Wondraschek R, Suselbeck T, Kiefer R, Balthasar V, Luik A et al (2012) Acute and late outcomes of transcatheter aortic valve implantation (TAVI) for the treatment of severe symptomatic aortic stenosis in patients at high- and low-surgical risk. J Interv Cardiol 25:364–374

    Article  PubMed  Google Scholar 

  17. Barbanti M, Yang TH, Rodes-Cabau J, Tamburino C, Wood DA, Jilaihawi H, Blanke P, Makkar RR et al (2013) Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement. Circulation 128(3):244–253

    Article  PubMed  Google Scholar 

  18. Abdel-Wahab M, Zahn R, Horack M, Gerckens U, Schuler G, Sievert H, Eggebrecht H, Senges J et al (2011) Aortic regurgitation after transcatheter aortic valve implantation: incidence and early outcome. Results from the German transcatheter aortic valve interventions registry. Heart 97:899–906

    Article  PubMed  Google Scholar 

  19. Tamburino C, Capodanno D, Ramondo A, Petronio AS, Ettori F, Santoro G, Klugmann S, Bedogni F et al (2011) Incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis. Circulation 123:299–308

    Article  PubMed  Google Scholar 

  20. Blanke P, Reinohl J, Schlensak C, Siepe M, Pache G, Euringer W, Geibel-Zehender A, Bode C et al (2012) Prosthesis oversizing in balloon-expandable transcatheter aortic valve implantation is associated with contained rupture of the aortic root. Circ Cardiovasc Interv 5:540–548

    Article  PubMed  Google Scholar 

  21. Rodes-Cabau J (2012) Transcatheter aortic valve implantation: current and future approaches. Nat Rev Cardiol 9:15–29

    Article  Google Scholar 

  22. Godino C, Pavon AG, Colombo A (2013) Long-term results after transcatheter aortic valve implantation: positive and side effects. Minerva Cardioangiol 61:377–391

    PubMed  CAS  Google Scholar 

  23. Sinning JM, Werner N, Vasa-Nicotera M, Ghanem A, Hammerstingl C, Grube E, Nickenig G (2013) Innovations and novel technologies in TAVI. Second generation transcatheter heart valves. Minerva Cardioangiol 61:155–163

    PubMed  CAS  Google Scholar 

  24. Binder RK, Webb JG, Willson AB, Urena M, Hansson NC, Norgaard BL, Pibarot P, Barbanti M et al (2013) The impact of integration of a multidetector computed tomography annulus area sizing algorithm on outcomes of transcatheter aortic valve replacement: a prospective, multicenter, controlled trial. J Am Coll Cardiol 62(5):431–438

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

Gerhard Schymik and Holger Schröfel are proctors and Peter Bramlage is a consultant for Edwards Lifesciences. No conflict of interest was declared by the other authors.

Author information

Authors and Affiliations

  1. Medical Clinic IV, Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestrasse 90, 76133, Karlsruhe, Germany

    Gerhard Schymik, Rainer Wondraschek, Armin Luik & Claus Schmitt

  2. Clinic for Cardiac Surgery Karlsruhe, Karlsruhe, Germany

    Martin Heimeshoff, Jan Gerhardus, Herbert Posival & Holger Schröfel

  3. Institut für Pharmakologie und Präventive Medizin, Mahlow, Germany

    Peter Bramlage

  4. Medical Clinic I, Department of Cardiology, Mannheim University, Mannheim, Germany

    Tim Süselbeck

Authors
  1. Gerhard Schymik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martin Heimeshoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Bramlage
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rainer Wondraschek
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tim Süselbeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jan Gerhardus
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Armin Luik
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Herbert Posival
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Claus Schmitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Holger Schröfel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gerhard Schymik.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schymik, G., Heimeshoff, M., Bramlage, P. et al. Ruptures of the device landing zone in patients undergoing transcatheter aortic valve implantation: an analysis of TAVI Karlsruhe (TAVIK) patients. Clin Res Cardiol 103, 912–920 (2014). https://doi.org/10.1007/s00392-014-0729-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-014-0729-8

Keywords

Search

Navigation