title: A novel calcium scoring system accurately predicts likelihood and location of post-TAVI paravalvular leak.
abstract: OBJECTIVE
  Sclerosis distribution, topography and morphology in aortic stenosis may have an impact on the localisation of post-procedural paravalvular leakage (PVL) following transcatheter aortic valve implantation (TAVI).
  
  
  METHODS
  Between 05/2005 and 03/2011 a total of 208 patients underwent either transapical (TA) or transvascular (TV) TAVI using the Edwards-SAPIEN(TM), or CoreValve(TM) system. Aortic cusp and annular sclerosis distribution and aortic valve sclerosis symmetry were evaluated by preoperative transesophageal echocardiography (TOE). Mild, moderate and severe PVL after TAVI (group 1, N.=117) were analysed and compared to those patients with no signs of postprocedural PVL (group 2, N.=91). Commercial available image processing and analysing software were used to evaluate all relevant calcific sections (aortic sclerosis score 0-66; symmetry score 0-5) and were matched with the localization of the PVLs.
  
  
  RESULTS
  A total of 117 patients (83±6 years, mean logistic EuroSCORE 20.1±12.7%) were identified with a mild-moderate PVL (TV, N.=102; TA, N.=15). Mean aortic sclerosis score was 38.7±7.6 in group 1 compared to 33.7±8.3 in group 2 (P<0.001) showing highest calcification in the non-coronary part for both groups. The mean symmetry score was 1.9±1.0 group 1 compared to 1.7±1.0 in group 2 (P=0.12). Regression analysis showed a significant relation of preoperative cusp localisation to the corresponding paravalvular leakage (P<0.001).
  
  
  CONCLUSIONS
  The present study shows that a aortic sclerosis score constructed by TOE enables prediction of postoperative PVL and moreover, the localisation of PVL after TAVI correlates with the corresponding preoperative amount of sclerosis for each cusp.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery West-German Heart Center Essen, Essen, Germany - daniel.wendt@uk-essen.de.
authors.forename: D
authors.initials: D
authors.lastname: Wendt
authors.forename: B
authors.initials: B
authors.lastname: Plicht
authors.forename: P
authors.initials: P
authors.lastname: Kahlert
authors.forename: K
authors.initials: K
authors.lastname: Hartmann
authors.forename: F
authors.initials: F
authors.lastname: Al-Rashid
authors.forename: V
authors.initials: V
authors.lastname: Price
authors.forename: T
authors.initials: T
authors.lastname: Konorza
authors.forename: R
authors.initials: R
authors.lastname: Erbel
authors.forename: H
authors.initials: H
authors.lastname: Jakob
authors.forename: M
authors.initials: M
authors.lastname: Thielmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D001022:Aortic Valve Insufficiency / Q000209:etiology*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000378:metabolism / Q000628:therapy*; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000378:metabolism / Q000628:therapy*; D002118:Calcium / Q000032:analysis*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012598:Sclerosis / Q000000981:diagnostic imaging / Q000378:metabolism / Q000628:therapy*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002118:Calcium