Tsuru Yasuo, Miura Mizuki, Shirai Shinichi, Hayashi Masaomi, Taninobu Kenji, Takiguchi Hiroshi, Ito Shinya, Yano Mariko, Kawaguchi Tomohiro, Morinaga Takashi, Isotani Akihiro, Kakumoto Shinichi, Seo Katsuhiro, Arai Yoshio, Sakaguchi Genichi, Ando Kenji
Department of Cardiology, Kokura Memorial Hospital.
Department of Clinical Engineering, Kokura Memorial Hospital.
Int Heart J. 2019 May 30;60(3):772-777. doi: 10.1536/ihj.18-484. Epub 2019 Apr 25.
Aortic complex rupture is one of the most critical complications associated with transcatheter aortic valve implantation (TAVI). Its incidence is rare, and its mechanism varies by case; therefore, it is difficult to identify the predictors of complex rupture. Herein, we report a clinical case series of aortic complex rupture. Within our cohort, the frequency of complex rupture was 0.8% (4/497 consecutive patients) with an in-hospital mortality of 0. Among these four patients with complex rupture, two underwent emergent thoracotomy and surgical hemostasis without a heart-lung machine and surgical aortic valve replacement, whereas the other two were conservatively managed. The case overview revealed the following similarities: all the patients were elderly, small women; balloon-expandable valves were used; the annulus area was small with heavily calcified leaflet; and aggressive treatment strategy was used (i.e., oversizing and post-dilatation). In such cases, TAVI should be performed with a careful strategy. Once aortic complex rupture occurs, damage can be minimized through cooperation with an institutional heart team and calm management.
