Aortic annulus rupture during transcatheter aortic valve implantation: safe aortic root replacement

A 88-year-old woman with severe symptomatic aortic stenosis underwent percutaneous transcatheter aortic valve implantation (TAVI), complicated by aortic annulus rupture. This was treated with emergency surgery in a hybrid operative suite (Figs 1 and 2). An 18-month follow-up negative for cardiac events is recorded. We highlight the need of performing TAVI in a hybrid room with a cardiac surgeon on stand-by. A cardiac tamponade occurred during inflation and valve delivery (balloon expandable Edwards Sapien 23). An emergency percutaneous pericardiocentesis was managed. The sternotomy immediately followed and the bleeding was initially controlled by firm digital compression of the aortic annulus rupture. After emergency cardiopulmonary bypass, the aortic annulus rupture was clearly shown and repaired with autologous pericardial patch. The total aortic root was replaced with Medtronic freestyle aortic root prosthesis.