{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T07:49:16Z","timestamp":1784015356473,"version":"3.55.0"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,11,13]],"date-time":"2023-11-13T00:00:00Z","timestamp":1699833600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,11,13]],"date-time":"2023-11-13T00:00:00Z","timestamp":1699833600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Cardiothorac Surg"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>Aortic annulus rupture remains one of the most fatal complications of TAVR. While attempts have been made to describe and predict this complication, the data remains insufficient without evidence-based guidelines for management of this rare complication.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Here we describe a series of 3 aortic annulus ruptures after TAVR which were managed successfully to hospital discharge.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Patient 1 suffered annulus rupture during balloon valvuloplasty prior to TAVR. The patient became hypotensive, and echocardiogram showed pericardial effusion. The patient underwent pericardiocentesis which transiently improved the blood pressure, but bleeding continued. The patient was transitioned to an open surgical aortic valve replacement due to ongoing hemorrhage. The chest was left open with delayed closure on post-op day 2. The patient was discharged on post-op day 15. Patient 2 was undergoing TAVR valve expansion. The patient became hypotensive. An echocardiogram revealed pericardial effusion. Pericardiocentesis yielded 200\u00a0mL of blood. SURGIFLO (Johnson &amp; Johnson Wound Management, Somerville, NJ) was injected into the pericardial space. Aortic root angiography confirmed no further contrast extravasation. A pericardial drain was left in place for 2\u00a0days, and the patient was discharged on post-op day 7. Patient 3 received a TAVR valve and post-placement dilation due to paravalvular leak. The echocardiogram showed a pericardial effusion. Pericardiocentesis was performed, yielding 500\u00a0cc of blood. The patient\u2019s healthcare proxy declined emergent surgery; thus, a pericardial drain was placed. No hemostatic agents were used, and drainage reduced over several hours. The drain was removed on post-op day 3, and the patient was discharged on post-op day 8.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Based on the timelines in these three cases, and interventions used, the following steps may be employed in the event of annulus rupture: identification of hemodynamic instability, echocardiogram to confirm pericardial effusion, emergent pericardiocentesis, pericardial drain placement for evacuation of the pericardial space and use of hemostatic agents, repeat aortogram to rule out ongoing extravasation. If hemostasis is unable to be achieved and\/or the patient becomes hemodynamically unstable at any point, rapid transition to emergent surgical management is necessary. This management strategy proved successful for this case series and warrants further investigation.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13019-023-02426-8","type":"journal-article","created":{"date-parts":[[2023,11,13]],"date-time":"2023-11-13T15:01:44Z","timestamp":1699887704000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Aortic annulus rupture after transcatheter aortic valve replacement: successful management of a dangerous complication"],"prefix":"10.1186","volume":"18","author":[{"given":"Andrew","family":"Jones","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hossein","family":"Amirjamshidi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Knight","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick S.","family":"Ling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Hisamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,11,13]]},"reference":[{"key":"2426_CR1","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/j.ajem.2022.03.042","volume":"56","author":"SG Rouleau","year":"2022","unstructured":"Rouleau SG, Brady WJ, Koyfman A, Long B. Transcatheter aortic valve replacement complications: a narrative review for emergency clinicians. Am J Emerg Med. 2022;56:77\u201386.","journal-title":"Am J Emerg Med"},{"issue":"2","key":"2426_CR2","doi-asserted-by":"publisher","first-page":"e53","DOI":"10.1016\/j.athoracsur.2018.02.081","volume":"106","author":"M Tochii","year":"2018","unstructured":"Tochii M, Muramatsu T, Amano K, et al. \u201cTwin icicle\u201d calcifications cause aortic annular rupture. Ann Thorac Surg. 2018;106(2):e53\u20135.","journal-title":"Ann Thorac Surg"},{"issue":"3","key":"2426_CR3","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1161\/CIRCULATIONAHA.113.002947","volume":"128","author":"M Barbanti","year":"2013","unstructured":"Barbanti M, Yang TH, Rod\u00e8s Cabau J, et al. Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement. Circulation. 2013;128(3):244\u201353.","journal-title":"Circulation"},{"issue":"6","key":"2426_CR4","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1016\/j.jccase.2017.07.009","volume":"16","author":"H Suzuyama","year":"2017","unstructured":"Suzuyama H, Sakamoto T, Konami Y, et al. An autopsy case of aortic root rupture with thin porcelain aorta during balloon-expandable transcatheter aortic valve implantation. J Cardiol Cases. 2017;16(6):186\u20138.","journal-title":"J Cardiol Cases"},{"issue":"4","key":"2426_CR5","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1161\/CIRCINTERVENTIONS.111.967349","volume":"5","author":"P Blanke","year":"2012","unstructured":"Blanke P, Rein\u00f6hl J, Schlensak C, et al. Prosthesis oversizing in balloon-expandable transcatheter aortic valve implantation is associated with contained rupture of the aortic root. 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Catheter Cardiovasc Interv. 2013;81(1):E72-75.","journal-title":"Catheter Cardiovasc Interv"}],"container-title":["Journal of Cardiothoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-023-02426-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13019-023-02426-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-023-02426-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,13]],"date-time":"2023-11-13T15:02:42Z","timestamp":1699887762000},"score":1,"resource":{"primary":{"URL":"https:\/\/cardiothoracicsurgery.biomedcentral.com\/articles\/10.1186\/s13019-023-02426-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,13]]},"references-count":13,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["2426"],"URL":"https:\/\/doi.org\/10.1186\/s13019-023-02426-8","relation":{},"ISSN":["1749-8090"],"issn-type":[{"value":"1749-8090","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,13]]},"assertion":[{"value":"8 April 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 November 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 November 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study was granted exemption from IRB approval by the University of Rochester RSRB\u00a0under the\u00a0Office of Human Subject Protection on the grounds that it did not constitute a human subject research study. A letter of exemption has been provided. RSRB# 7434.This letter and relevant documentation are available from the authors upon request.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Consent was obtained (when possible) from the subjects for publication of this case series.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Written consent was obtained for capturing anonymized patient photos.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The authors have no conflicts of interest or financial disclosures to disclose.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interest"}}],"article-number":"321"}}