Rupture of the device landing zone during transcatheter aortic valve implantation: a life-threatening but treatable complication

Abstract

BACKGROUND: Iatrogenic damage of different structures of the aortic root, in the region of the so-called "device landing zone," may occur during transcatheter aortic valve implantation (TAVI). It is mostly considered difficult to treat or even untreatable.
METHODS AND RESULTS: We performed a retrospective analysis of the occurrence, clinical presentation, treatment, and outcome of iatrogenic rupture in the device landing zone in a series of 618 consecutive patients who underwent TAVI at our institution between April 2008 and October 2011. The incidence of rupture was 1% (6 patients). The correct diagnosis was established during TAVI procedures in 4 and postmortem in 2 patients. The major sign of the aortic rupture was apparent bleeding in 4 patients and failure of myocardial recovery after valve implantation in 1; it was asymptomatic in 1 patient. The iatrogenic rupture in the region of the device landing zone was treated surgically in 5 patients and only conservatively in the patient without symptoms. When the diagnosis was established correctly during TAVI, only 1 of 4 patients died (25%). The overall mortality rate was 50% (3 of 6 patients died).
CONCLUSIONS: Rupture of different structures in the device landing zone during TAVI is a life-threatening complication that can be treated successfully if it is immediately recognized and adequately managed.