Correlation of Device landing zone calcification and acute procedural success in patients undergoing transcatheter aortic valve implantations with the self-expanding CoreValve prosthesis.
OBJECTIVE
The aim of this study was to assess the influence of amount and distribution of calcifications of the aortic valve and the left ventricular outflow tract on the acute procedural outcome of patients undergoing transcatheter aortic valve implantation (TAVI).


BACKGROUND
Transcatheter aortic valve implantation is a new percutaneous technique especially for elderly, high-risk patients with significant aortic valve stenosis (AS). After TAVI, post-interventional paravalvular aortic regurgitations (PAR) can occur, which is believed to be related partially to valve calcifications.


METHODS
We prospectively analyzed 100 symptomatic patients with severe AS scheduled for TAVI with the CoreValve ReValving (Medtronic, Minneapolis, Minnesota) prosthesis. In all patients, a native and contrast-enhanced multislice cardiac computed tomography was performed pre-interventionally. Calcification load of the valve and the adjacent outflow tract was estimated by the Agatston Score (AgS), and the amount and distribution of calcification was semi-quantitatively assessed and graded on a 1 to 4 scale (device "landing zone" calcification score [DLZ-CS]). Aortography was performed to evaluate the PAR pre-interventionally, after initial device release (PAR0) and after termination of the procedure (PAR1). Transthoracic echocardiography was performed 2 weeks after implantation (PAR2).


RESULTS
The AgS and DLZ-CS showed a significant correlation with the grade of PAR0 (AgS: r = 0.329, p = 0.001; DLZ-CS: r = 0.356, p < 0.001), PAR1 (AgS: r = 0.254, p = 0.011; DLZ-CS: r = 0.240, p = 0.016), and PAR2 (AgS: r = 0.341, p = 0.001; DLZ-CS: r = 0.300, p = 0.002). Both scores (AgS and DLZ-CS) showed a significant positive correlation (r = 0.858, p < 0.001).


CONCLUSIONS
Calcification in the CoreValve device "landing zone" shows a significant positive correlation to PAR after TAVI. Furthermore, the need for "second maneuvers" (i.e., post-dilation after initial device release) can be predicted by these calcification scores (AgS and DLZ-CS).
John
Daniel
D
Department of Cardiology/Angiology, HELIOS Heart Center Siegburg, Siegburg, Germany.
Buellesfeld
Lutz
L
Yuecel
Seyrani
S
Mueller
Ralf
R
Latsios
Georg
G
Beucher
Harald
H
Gerckens
Ulrich
U
Grube
Eberhard
E
D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000601:surgery*; D002114:Calcinosis / Q000473:pathology / Q000601:surgery; D006328:Cardiac Catheterization / Q000009:adverse effects*; D005260:Female; D006305:Health Status Indicators; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012044:Regression Analysis; D013223:Statistics as Topic