title: Aortic valve calcification as a predictor of location and severity of paravalvular regurgitation after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  To determine whether the location of aortic valve calcium (AVC) influences the location of paravalvular regurgitation (PR). PR is an adverse effect of transcatheter aortic valve implantation (TAVI) with a negative effect on long-term patient survival. The relationship between AVC and the occurrence of PR has been documented. However, the relationship between the distribution of AVC and the location of PR is still sparsely studied. The purpose of this study was to correlate severity and location of AVC with PR in patients treated with TAVI.
  
  
  METHODS
  Fifty-six consecutive patients who underwent transaortic or transapical TAVI and had preoperative computed tomography scans were included in this retrospective study. The volume, mass and location of AVC was determined and compared between patients with and without PR using a non-parametric t-test. Postoperative echocardiography was performed to determine the presence and location of PR, which was associated with the cusp with highest AVC using a χ(2) test.
  
  
  RESULTS
  Valve deployment was successful in all 56 patients. PR was present in 38 patients (68%) after TAVI. There was a non-significantly higher volume of AVC in the PR group [214 (70-418) vs 371 (254-606) cm(3), P = 0.15]. AVC mass was significantly higher in patients with PR than in patients without PR [282 (188-421) vs 142 (48-259) mg, respectively, P = 0.043]. The location of PR was determined in 36 of these patients. Of these 36 patients, PR occurred at the cusp with the highest AVC in 20 patients (56%, χ(2) P = 0.030).
  
  
  CONCLUSIONS
  In our population, PR was associated with greater AVC mass. Moreover, the location of PR was associated with the cusp with the highest amount of AVC.
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Centre, Amsterdam, Netherlands e.y.koh@amc.uva.nl.
authors.forename: Ezra Y
authors.initials: EY
authors.lastname: Koh
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: Kayan Y
authors.initials: KY
authors.lastname: Lam
authors.affiliation: Department of Cardiology, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: Navin R
authors.initials: NR
authors.lastname: Bindraban
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Cocchieri
authors.affiliation: Department of Radiology, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: R Nils
authors.initials: RN
authors.lastname: Planken
authors.affiliation: Department of Cardiology, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: Karel T
authors.initials: KT
authors.lastname: Koch
authors.affiliation: Department of Cardiology, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Baan
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: Bas A
authors.initials: BA
authors.lastname: de Mol
authors.affiliation: Department of Radiology, Academic Medical Centre, Amsterdam, Netherlands Department of Biomedical Engineering and Physics, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: Henk A
authors.initials: HA
authors.lastname: Marquering
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002114:Calcinosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006328:Cardiac Catheterization / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: Aortic valve calcium; Paravalvular regurgitation; Transcatheter aortic valve implantation