title: Transcatheter Aortic Valve Implantation With Different Valve Designs for Severe Device Landing Zone Calcification.
abstract: Severe device landing zone calcification (DLZ-CA) predicted paravalvular leak (PVL) and post-dilatation (PD) after transcatheter aortic valve implantation (TAVI). The aim of this study was to determine the influence of DLZ-CA on PVL or PD rates after SAPIEN XT (XT) versus CoreValve (CV).We analyzed patients undergoing TAVI who had severe DLZ-CA. Severe DLZ-CA defined the upper left ventricular outflow tract calcification; the cross-sectional region 2 mm inferior to the annular plane. PVL was evaluated at 30days using transthoracic echocardiography. Overall, 133 patients had XT-TAVI and the remaining 41 patients had CV-TAVI. Two patients had annulus injury in the XT group (oversizing 20.2% and 20.5% for two XT cases). PD was less frequently performed in the XT group (34.1% versus 12.8%; P = 0.002), but PVL rates were similar between both groups (42.1% versus 41.5% for the XT and CV groups, respectively; P = 0.94). Importantly, excessive oversizing or the degree of filling volume was not associated with decreased PVL after XT-TAVI (P = non-significant for all). On multivariate analysis, CV-TAVI was found to be one of the independent predictors of need for PD (Odds ratio 3.63, 95% confidence interval 1.55 to 8.53, P = 0.003).In the setting of severe DLZ-CA, XT and CV have similar rates of PVL but XT had less need for PD. Excessive oversizing with XT carries a risk of root injury which could be further increased by DLZ-CA.
authors.affiliation: Cedars-Sinai Heart Institute.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Maeno
authors.forename: Yigal
authors.initials: Y
authors.lastname: Abramowitz
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kazuno
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kawamori
authors.forename: Geeteshwar
authors.initials: G
authors.lastname: Mangat
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Takahashi
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.forename: Mamoo
authors.initials: M
authors.lastname: Nakamura
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D002114:Calcinosis / Q000209:etiology*; D004106:Dilatation; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000295:instrumentation