Browsing by Subject "Multidetector computed tomography"

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    Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement
    (Lippincott, Williams & Wilkins, 2013-06-07) Barbanti, Marco; Yang, Tae-Hyun; Rodès Cabau, Josep; Tamburino, Corrado; Wood, David A.; Jilaihawi, Hasan; Blanke, Philips; Makkar, Raj R.; Latib, Azeem; Colombo, Antonio; Tarantini, Giuseppe; Raju, Rekha; Binder, Ronald K.; Nguyen, Giang; Freeman, Melanie; Ribeiro, Henrique B.; Kapadia, Samir; Min, James; Feuchtner, Gudrun; Gurtvich, Ronen; Alqoofi, Faisal; Pelletier, Marc; Ussia, Gian Paolo; Napodano, Massimo; Sandoli de Brito, Fabio; Kodali, Susheel; Norgaard, Bjarne L.; Hansson, Nicolaj C.; Pache, Gregor; Canovas López, Sergio; Zhang, Hongbin; Leon, Martin B.; Webb, John G.; Leipsic, Jonathon; Cirugía, Pediatría y Obstetricia y Ginecología
    Background—Aortic root rupture is a major concern with balloon-expandable transcatheter aortic valve replacement (TAVR). We sought to identify predictors of aortic root rupture during balloon-expandable TAVR by using multidetector computed tomography. Methods and Results—Thirty-one consecutive patients who experienced left ventricular outflow tract (LVOT)/annular/aortic contained/noncontained rupture during TAVR were collected from 16 centers. A caliper-matched sample of 31 consecutive patients without annular rupture, who underwent pre-TAVR multidetector computed tomography served as a control group. Multidetector computed tomography assessment included short- and long-axis diameters and cross-sectional area of the sinotubular junction, annulus, and LVOT, and the presence, location, and extent of calcification of the LVOT, as well. There were no significant differences between the 2 groups in any preoperative clinical and echocardiographic variables. Aortic root rupture was identified in 20 patients and periaortic hematoma in 11. Patients with root rupture had a higher degree of subannular/LVOT calcification quantified by the Agatston score (181.2±211.0 versus 22.5±37.6, P<0.001), and a higher frequency of ≥20% annular area oversizing (79.4% versus 29.0%, P<0.001) and balloon postdilatation (22.6% versus 0.0%, P=0.005). In conditional logistic regression analysis for the matched data, moderate/severe LVOT/subannular calcifications (odds ratio, 10.92; 95% confidence interval, 3.23–36.91; P<0.001) and prosthesis oversizing ≥20% (odds ratio, 8.38; 95% confidence interval, 2.67–26.33; P<0.001) were associated with aortic root contained/noncontained rupture. Conclusions—This study demonstrates that LVOT calcification and aggressive annular area oversizing are associated with an increased risk of aortic root rupture during TAVR with balloon-expandable prostheses. Larger studies are warranted to confirm these findings.
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    The impact of calcium volume and distribution in aortic root injury related to balloon-expandable transcatheter aortic valve replacement
    (Elsevier, 2015-09) Hansson, Nicolaj C.; Noorgaard, Bjarne L.; Barbanti, Marco; Nielsen, Niels Erik; Yang, Tae-Hyun; Tamburino, Corrado; Dvir, Danny; Jilaihawi, Hasan; Blanke, Phillip; Makkar, Raj R.; Latib, Azeem; Colombo, Antonio; Tarantini, Giuseppe; Raju, Rekha; Wood, David; Andersen, Henning R.; Ribeiro, Henrique B.; Kapadia, Samir; Min, James; Feuchtner, Gudrun; Gurvitch, Ronen; Alqoofi, Faisal; Pelletier, Marc; Ussia, Gian Paolo; Napodano, Massimo; Sandoli de Brito Jr., Fabio; Kodali, Susheel; Pache, Gregor; Cánovas López, Sergio; Berger, Adam; Murphy, Darra; Svensson, Lars G.; Rodés Cabau, Josep; Leon, Martin B.; Webb, John G.; Leipsic, Jonathon; Cirugía, Pediatría y Obstetricia y Ginecología
    Background A detailed assessment of calcium within the aortic root may provide important additional information regarding the risk of aortic root injury during transcatheter heart valve replacement (TAVR). Objective We sought to delineate the effect of calcium volume and distribution on aortic root injury during TAVR. Methods Thirty-three patients experiencing aortic root injury during TAVR with a balloon-expandable valve were compared with a control group of 153 consecutive TAVR patients without aortic root injury (as assessed by post-TAVR multidetector CT). Using commercial software to analyze contrast-enhanced pre-TAVR CT scans, calcium volume was determined in 3 regions: (1) the overall left ventricular outflow tract (LVOT), extending 10 mm down from the aortic annulus plane; (2) the upper LVOT, extending 2 mm down from the annulus plane; and (3) the aortic valve region. Results Calcium volumes in the upper LVOT (median, 29 vs 0 mm3; P < .0001) and overall LVOT (median, 74 vs 3 mm3; P = .0001) were higher in patients who experienced aortic root injury compared with the control group. Calcium in the aortic valve region did not differ between groups. Upper LVOT calcium volume was more predictive of aortic root injury than overall LVOT calcium volume (area under receiver operating curve [AUC], 0.78; 95% confidence interval, 0.69–0.86 vs AUC, 0.71; 95% confidence interval, 0.62–0.82; P = .010). Upper LVOT calcium below the noncoronary cusp was significantly more predictive of aortic root injury compared to calcium underneath the right coronary cusp or the left coronary cusp (AUC, 0.81 vs 0.68 vs 0.64). Prosthesis oversizing >20% (likelihood ratio test, P = .028) and redilatation (likelihood ratio test, P = .015) improved prediction of aortic root injury by upper LVOT calcium volume. Conclusion Calcification of the LVOT, especially in the upper LVOT, located below the noncoronary cusp and extending from the annular region, is predictive of aortic root injury during TAVR with a balloon-expandable valve.