title: Morphological Characteristics and Calcification of the Native Aortic Valve and the Relation to Significant Aortic Regurgitation after CoreValve TAVI.
abstract: Aortic regurgitation (AR) is a frequent and life-limiting complication after transcatheter aortic valve implantation (TAVI). The study aim was to relate post-TAVI AR, using a self-expandable stent, to detailed baseline anatomical and morphological characteristics of the native aortic valve.
  
  
  
  A total of 82 patients (40 males, 42 females; mean age 80 ± 7 years) who received a Medtronic CoreValve implant was included. Aortic root morphology, aortic annulus and implant size mismatch, implant position, extent of aortic annulus and leaflet calcification, the connected sub-annular calcification volume, and their distribution were quantified based on computed tomography scan analysis. AR following TAVI was quantified using standardized angiography and echocardiography.
  
  
  
  The mean logistic EuroSCORE of all patients was 16.9 ± 11.1%. According to angiography and echocardiography, 41% and 39% respectively, of the patients had AR grade ≥2. The two methods correlated moderately (Spearman's ρ = 0.51, p <0.001). The maximal diameter of the native annulus was larger in patients with significant AR after TAVI based on echocardiography (28.0 mm versus 26.8 mm, p = 0.059). Excessive calcification, especially on the left coronary cusp, was present in patients with significant AR, based on angiography (AR ≥II 71.0 mm3 versus AR <II 26.3 mm3, p = 0.001) as well as on echocardiography (AR ≥II 59.9 mm3 versus AR <II 34.0 mm3, p = 0.016).
  
  
  
  Of the evaluated characteristics, a larger volume of calcification (especially on the left coronary cusp) is most related to the development of significant AR (grade II-IV) following implantation, when quantified by both angiography and echocardiography.
authors.affiliation: University of Antwerp, Department of Translational Pathophysiological Research, Cardiovascular Diseases, Faculty of Medicine and Health Sciences, Antwerp, Belgium.|Materialise N.V., Leuven, Belgium.|KULeuven, Department of Biomedical Engineering, Faculty of Engineering Science, Leuven, Belgium. Electronic correspondence: Bart.Bosmans@kuleuven.be.
authors.forename: Bart
authors.initials: B
authors.lastname: Bosmans
authors.affiliation: University of Antwerp, Department of Translational Pathophysiological Research, Cardiovascular Diseases, Faculty of Medicine and Health Sciences, Antwerp, Belgium.
authors.forename: Valérie
authors.initials: V
authors.lastname: Collas
authors.affiliation: Materialise N.V., Leuven, Belgium.
authors.forename: Eva
authors.initials: E
authors.lastname: Verhoelst
authors.affiliation: University of Antwerp, Department of Translational Pathophysiological Research, Cardiovascular Diseases, Faculty of Medicine and Health Sciences, Antwerp, Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: Paelinck
authors.affiliation: KULeuven, Department of Biomedical Engineering, Faculty of Engineering Science, Leuven, Belgium.
authors.forename: Jos
authors.initials: J
authors.lastname: Vander Sloten
authors.affiliation: University of Antwerp, Department of Translational Pathophysiological Research, Cardiovascular Diseases, Faculty of Medicine and Health Sciences, Antwerp, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Bosmans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000473:pathology*; D001024:Aortic Valve Stenosis / Q000601:surgery; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000473:pathology*; D004452:Echocardiography; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*