Percutaneous Management Of Aortic Root Rupture During Transcatheter Aortic Valve Replacement With Coil Embolization

Aortic root rupture is a rare, but potentially fatal, complication of transcatheter aortic valve replacement (TAVR).1,2 Despite the advances in TAVR technology, aortic root rupture continues to be associated with high mortality because of the lack of effective treatment options for this complication. We describe 2 cases of aortic root rupture occurring during TAVR that were managed percutaneously with coil embolization of the periaortic space created by the root rupture.A 79-year-old patient underwent TAVR with a 29-mm Evolut R (Medtronic, Inc, Minneapolis, MN). Pre-TAVR computed tomography revealed annular perimeter 81.6 mm (mean diameter, 26.0 mm). Because of significant paravalvular aortic regurgitation (Figure 1A; Movie IA in the Data Supplement), post-dilation was performed with a 26 mm×4.5 cm True Balloon (Figure 1B; Movie IB in the Data Supplement). Immediately after post-dilation, a large pericardial effusion was noted (Figure 1C; Movie IC in the Data Supplement). Emergent pericardiocentesis was performed. Selective injection into the left coronary cusp with a 6F XB-LAD 3.5 guide catheter revealed the site of aortic root rupture in the left coronary sinus, with contrast extravasating into the pericardial space (Figure 1D and 1E; Movie ID …