title: Device landing zone calcification and its impact on residual regurgitation after transcatheter aortic valve implantation with different devices.
abstract: OBJECTIVE
  Calcification of the device landing zone is linked to paravalvular regurgitation after transcatheter aortic valve implantation (TAVI). The mechanisms remain incompletely understood and the performance of next-generation transcatheter heart valves (THV) has not been investigated. We evaluated the impact of calcification patterns on residual aortic regurgitation (AR) after TAVI with different THV in patients with severe aortic stenosis.
  
  
  RESULTS
  TAVI was performed in 537 patients at two centres. Devices implanted were the Edwards Sapien XT (n = 254), Medtronic CoreValve (n = 123), JenaValve (n = 62), Medtronic Engager (n = 56), and Symetis Acurate (n = 42) prostheses. Calcification of the device landing zone was retrospectively assessed from contrast-enhanced multidetector computed tomography data and correlated with echocardiographic and clinical data. Calcium volumes of the aortic valve and left-ventricular outflow tract were associated with residual AR: No AR, 604 mm(3) (inter-quartile range, IQR 349-916); trace AR, 639 mm(3) (IQR 368-948); mild AR, 710 mm(3) (IQR 412-2078); ≥moderate AR, 1041 mm(3) (IQR 791-1417, P = 0.001). Device landing zone calcium, particularly if located in the left-ventricular outflow tract, and a low cover index were predictive of AR. Differences in the incidence of AR were observed with regard to THV type. Higher calcium volume was associated with the need for post-dilation (n = 134, median 852 [IQR 342-945] vs. 604 [IQR 542-1207] mm(3), P < 0.001).
  
  
  CONCLUSIONS
  Calcification of the device landing zone, particularly if located inferior to the annulus, was independently associated with residual AR after TAVI with all evaluated THV; however, the incidence of paravalvular leakage differed significantly between the devices implanted.
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistrasse 52, Hamburg 20246, Germany m.seiffert@uke.de.
authors.forename: Moritz
authors.initials: M
authors.lastname: Seiffert
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany.
authors.forename: Buntaro
authors.initials: B
authors.lastname: Fujita
authors.affiliation: Department of Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Maxim
authors.initials: M
authors.lastname: Avanesov
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistrasse 52, Hamburg 20246, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: Lunau
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schön
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Lenard
authors.initials: L
authors.lastname: Conradi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany.
authors.forename: Emir
authors.initials: E
authors.lastname: Prashovikj
authors.affiliation: Department of Cardiology, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany.
authors.forename: Smita
authors.initials: S
authors.lastname: Scholtz
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Börgermann
authors.affiliation: Department of Cardiology, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Scholtz
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistrasse 52, Hamburg 20246, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schäfer
authors.affiliation: Department of Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Lund
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Ensminger
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Treede
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D003287:Contrast Media / Q000494:pharmacology; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005858:Germany; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods
chemical_list: D003287:Contrast Media
keywords: TAVI; aortic regurgitation; calcification; device landing zone; transcatheter heart valve