title: Relation between calcium burden, echocardiographic stent frame eccentricity and paravalvular leakage after corevalve transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Paravalvular aortic leakage (PVL) after transcatheter aortic valve implantation (TAVI) is a complication with potentially severe consequences. The relation between native aortic root calcium burden, stent frame eccentricity and PVL was not studied before.
  
  
  RESULTS
  Two-hundred-and-twenty-three consecutive patients with severe aortic stenosis who underwent TAVI with a Medtronic CoreValve System© and who had available pre-discharge transthoracic echocardiography were studied. Echocardiographic stent inflow frame eccentricity was defined as major-minor diameter in a short-axis view >2 mm. PVL was scored according to the updated Valve Academic Research Consortium (VARC-2) recommendations. In a subgroup of 162 (73%) patients, the calcium Agatston score was available. Stent frame eccentricity was seen in 77 (35%) of patients. The correlation between the Agatston score and stent frame eccentricity was significant (ρ = 0.241, P = 0.003). Paravalvular leakage was absent in 91 cases (41%), mild in 67 (30%), moderate in 51 (23%), and severe in 14 (6%) cases. The correlation between stent frame eccentricity and PVL severity was significant (ρ = 0.525, P < 0.0001). There was a relation between particular eccentric stent frame shapes and the site of PVL.
  
  
  CONCLUSIONS
  Calcification of the aortic annulus is associated with a subsequent eccentric shape of the CoreValve prosthesis. This eccentric shape results in more PVL, with the localization of PVL related to the shape of stent frame eccentricity.
authors.affiliation: Department of Cardiology, Ospedali Riuniti, Università degli Studi di Foggia, Foggia, Italy.|Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Luigi F M
authors.initials: LFM
authors.lastname: Di Martino
authors.affiliation: Department of Cardiology, Ospedali Riuniti, Università degli Studi di Foggia, Foggia, Italy.|Cardialysis Cardiovascular Core Laboratory, Rotterdam, The Netherlands.
authors.forename: Osama I I
authors.initials: OII
authors.lastname: Soliman
authors.affiliation: Department of Cardiology, Ospedali Riuniti, Università degli Studi di Foggia, Foggia, Italy.
authors.forename: Lennart
authors.initials: L
authors.lastname: van Gils
authors.affiliation: Department of Cardiology, Ospedali Riuniti, Università degli Studi di Foggia, Foggia, Italy.
authors.forename: Wim B
authors.initials: WB
authors.lastname: Vletter
authors.affiliation: Department of Cardiology, Ospedali Riuniti, Università degli Studi di Foggia, Foggia, Italy.
authors.forename: Nicolas M
authors.initials: NM
authors.lastname: Van Mieghem
authors.affiliation: Department of Cardiology, Ospedali Riuniti, Università degli Studi di Foggia, Foggia, Italy.
authors.forename: Ben
authors.initials: B
authors.lastname: Ren
authors.affiliation: Department of Cardiology, Ospedali Riuniti, Università degli Studi di Foggia, Foggia, Italy.
authors.forename: Tjebbe W
authors.initials: TW
authors.lastname: Galema
authors.affiliation: Department of Cardiology, Ospedali Riuniti, Università degli Studi di Foggia, Foggia, Italy.
authors.forename: Carl
authors.initials: C
authors.lastname: Schultz
authors.affiliation: Department of Cardiology, Ospedali Riuniti, Università degli Studi di Foggia, Foggia, Italy.
authors.forename: Peter P T
authors.initials: PPT
authors.lastname: de Jaegere
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Matteo
authors.initials: M
authors.lastname: Di Biase
authors.affiliation: Department of Cardiology, Ospedali Riuniti, Università degli Studi di Foggia, Foggia, Italy.
authors.forename: Marcel L
authors.initials: ML
authors.lastname: Geleijnse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000601:surgery; D015331:Cohort Studies; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015607:Stents; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000379:methods
keywords: TAVR; aortic; calcification; eccentricity; echocardiography; regurgitation; stenosis; valve