Contained Annulus Rupture after TAVR: What Should We Do?

Courtesy of Dr. Carlos Fava.

Aortic annulus rupture is a catastrophic event that presents in nearly 0.9% of cases, but there is another entity called contained annulus rupture, associated to oversized devices and annulus calcification and diagnosed with CT angiography, with up to 5% frequency.

1602 patients from the ENCORE registry were analyzed. 21 of these patients presented contained annulus rupture (1.3%). 

Mean age was 81.9 years, 18 were women and most of them received self-expandable valves.

In 17 cases, contained annulus rupture was diagnosed with CT angiography, in 2 with transesophageal echocardiography (TEE), and in the remaining 2 with post TAVR CT angiography, due to clinical suspicion. 

Follow up was at 2.3 years. No patient presented symptoms or required reintervention and 9 died of non-cardiac cause. 

Read also: The FDA Approves Ticagrelor for Primary Prevention in High Risk Patients.

After angio CT at follow-up, one presented regression, 7 remained stable and 3 presented remission. 

Conclusion

Outcomes of this international multicenter registry show that contained annulus rupture had a favorable evolution, with supports the strategy of “watch and wait” used with these patients. 

Courtesy of Dr. Carlos Fava.

Original Title: Long-term follow-up of patients with contained annulus ruptures after TAVI: the EuropeaN COntained RupturE (ENCORE) Registry.

Reference: Philipp Breitbart,et al. EuroIntervention 2020;16:83-8.

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