Annulus Rupture After Tavi With A Ballon Expandable Valve - Always A Hopeless Complication?
Christoph Krapf, Lukas Stastny, Christoph Brenner, Bernhard Metzler, Guy Friedrich, Michael Grimm, Axel Bauer, Nikolaos Bonaros.
Medical University Innsbruck, Innsbruck, Austria.
BACKGROUND: Rupture of the aortic annulus during TAVI procedure is a rare but fatal complication, if not emergently operated. Due to age and comorbidities of the TAVI patients, the benefit of emergent "rescue" surgery is unclear. To address this question, we present our data.
METHODS: In the time period since 2012 we identified 6 (0.8%) patients out of 720 who had an acute annulus rupture during TAVI procedure. Median age was 84.5 years (75-88), median log Euroscore was 18.1 (9.5-32) and median STS score was 4.7 (2.4-6.0). A retrospective analysis for intraoperative course, outcome and 30-day mortality was performed.
RESULTS: In all patients a balloon expendable valve was implanted. One patient got symptomatic five hours after TAVI procedure in the ICU and deceased after prolonged resuscitation. In the other five patients the haemodynamic instability was identified in the operation room and emergency surgery was performed immediately. One patient remained stable and recovered well after pericardial drainage - the TAVI prosthesis might have sealed the rupture. Four patients were taken to the heart lung machine and were treated with conventional aortic valve replacement and repair of the aortic annulus with or without pericardial patch via full sternotomy. Two of these patients recovered well and were discharged home. One patient suffered from severe cerebral injury and deceased 3 weeks after. In one patient annulus destruction was too severe and he died in the operating room.
CONCLUSIONS: Annulus rupture after TAVI is a rare condition. Acute and perioperative mortality is profoundly high but emergency surgery rescued three out of five patients in our case series. This confirms the additional safety benefit of available cardiac surgery when doing TAVI procedures.
Back to 2022 Display Posters