title: Balloon-expandable transcatheter aortic valve replacement in patients with extreme aortic valve calcification.
abstract: OBJECTIVE
  To assess the procedural and short-term clinical outcome of performing balloon-expandable TAVR in patients with extremely calcified aortic valves.
  
  
  BACKGROUND
  Quantity of aortic valve calcification predicts rates of paravalvular regurgitation (PVR) post transcatheter aortic valve replacement (TAVR). Nonetheless, short-term outcomes of balloon-expandable TAVR in patients with extremely high calcified aortic valves have not been previously described.
  
  
  METHODS
  We studied patients with severe aortic stenosis that underwent balloon-expandable TAVR and had a pre-procedural non-contrast CT. Twenty patients that had aortic valve calcification score (AVCS) of more than 8,000 Agatston Units were compared to 279 patients with lower calcification scores. TAVR endpoints, device success and adverse events were considered according to the Valve Academic Research Consortium-2 definitions.
  
  
  RESULTS
  Device success was 80% in the extremely high calcification group compared to 95.3% in patients with less calcified aortic valves (P = 0.004). There was significantly more postprocedural PVR in the extreme calcification group: 50%, 35%, 10%, 5% vs. 72.4%, 25.8%, 1.8%, 0% for no/trace, mild, moderate and severe PVR, respectively (P < 0.001). There was one case of ascending aortic perforation resulting in intramural hematoma that resolved with no treatment. In-hospital mortality, new pacemaker implantation and major complications were similar between groups.
  
  
  CONCLUSIONS
  Balloon-expandable TAVR in patients with extremely calcified aortic valve is associated with lower device success and greater risk of PVR. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Yigal
authors.initials: Y
authors.lastname: Abramowitz
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kashif
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: George
authors.initials: G
authors.lastname: Matar
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Babak
authors.initials: B
authors.lastname: Hariri
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Jigar
authors.initials: J
authors.lastname: Patel
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Mamoo
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
mesh_terms: D000369:Aged, 80 and over; D000792:Angiography; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D002114:Calcinosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004452:Echocardiography; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D065467:Transcatheter Aortic Valve Replacement / Q000295:instrumentation*
keywords: aortic valve disease; electron beam CT/multidetector CT; imaging; percutaneous intervention