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My worst nightmare in the last 10 years practicing interventional cardiology. Annular rupture during TAVR with BEV. Emergent surgery was triggered but the patient couldn’t get out of extracorporeal circulation after valve replacement.

Evandro Martins F. MD

20,598 subscribers

37,780 次观看 • 2 年前 •via X (Twitter)

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Jorge A. Chavarria V. 🇨🇦 🇪🇸 🇨🇷. 的头像

Jorge A. Chavarria V. 🇨🇦 🇪🇸 🇨🇷.2 年前

2/2 more than device related, also the location of this Ca is relevant. This cases helps to discuss retrospectively more easier. Strong guy to share with us. In complex anatomies we need good CT quality to push this boundaries. Thanks @evandrofilhobr

Evandro Martins F. MD 的头像

Evandro Martins F. MD2 年前

Agree jorge calcium distribution was the problem, fusion of R-L cusps formed a stalactite of calcium, the valve rather than squeezing the calcium pushed that hard sharpe rock against soft tissue and acted like a knife 🔪

Abdel Almanfi, MD, FACC, FSCAI 的头像

Abdel Almanfi, MD, FACC, FSCAI2 年前

Sorry for what happened to your pt, it is inherited risk that comes with BE technology that relies on balloon 🎈 & rapid pacing .. Many things could go wrong! The key is to always be very cognizant re. valve type selection/sizing for each individual patient need’s and risk profile! @Dasisimulations can help.

Amr Abdelrahman 的头像

Amr Abdelrahman2 年前

Nasty looking long calcified raphe! What size sapien you have used? Annular measurement suggests with 29, however with this anatomy S3 26 might seal better especially if you aim high 100/0 implant or even a bit more. Thanks for sharing Evandro!

Somalaram Venkatesh 的头像

Somalaram Venkatesh2 年前

Tough luck! Takes courage to teach by showing difficult outcomes. Thanks for sharing the case 🙏🏽

Musa A. Sharkawi 的头像

Musa A. Sharkawi2 年前

Incredibly brave for you to share this. Thank you. We’ve done two bicuspids with calcium scores over 5500 each this past month, but raphes weren’t too calcified. Calcified raphes are probably the highest risk TAVR anatomy.

Dimitri Zappi, M.D. 的头像

Dimitri Zappi, M.D.2 年前

Everyday learning Evandro,it is what medicine painfully teach us.Alongside bulky Ca++of LVOF, these kind of very asymetrical bulkyCa++“make me nervous”,even in tricuspid anatomies.🎈 tends to⬆️expand to the portion w/o Ca++.🪟for pre #TAVR “shockwave” strategy in the near future?

Xacobe Flores Rios 的头像

Xacobe Flores Rios2 年前

Last year we had an aortic annulus rupture after a BEV TAVR in a 83yo patient. After emergent pericardiocentesis, we were able to close it with an #avp4 plug.

Felipe Díez del Hoyo 的头像

Felipe Díez del Hoyo2 年前

Thanks 4 sharing and let us learn. Anular/LVOT rupture is catastrophic and many times unpreventable with 🎈 expandable. Pt had ⬆️Ca++, but it seems calcium did not invade LVOT. In retrospect, wd u have chosen a self-expanding with the ct-scan info?

William Suh, MD 的头像

William Suh, MD2 年前

Sorry that this happened. Calcium spikes are huge problem. If pt is SAVR candidate then send to SAVR regardless of their preference. If TAVR only option, then add balloon sizing with contrast injection esp for bicuspid valves

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