title: Severe aortic stenosis with low aortic valve calcification: characteristics and outcome following transcatheter aortic valve implantation.
abstract: OBJECTIVE
  High aortic valve calcification (AVC) assessed with CT may be used to differentiate between severe and non-severe aortic stenosis (AS). Nonetheless, in some cases patients with low calcification are diagnosed with haemodynamically severe AS. The prevalence, mechanism of valve stenosis and implications for transcatheter aortic valve implantation (TAVI) of low AVC severe AS remain unclear. We assessed the clinical and haemodynamic characteristics and the outcome of patients with severe AS and low AVC that undergo TAVI.
  
  
  RESULTS
  Ninety-three patients that had low CT aortic valve calcification score (AVCS) were compared to 470 patients with high AVCS. High gradient severe AS was found among 53.8% (50/93) of the patients with low AVCS vs. 86% (404/470) of the patients with high AVCS (P < 0.001). Device success rate was similar between both groups. There were significantly lower rates of postprocedural paravalvular regurgitation (PVR) in the low AVCS group (≥ mild PVR: 12.9% vs. 23.6%; P = 0.03). Overall, there were only two cases (0.4%) of valve embolization in patients with high AVCS and 1 (1.1%) in patients with low AVCS (P = 0.42). Thirty-day mortality and major complications were similar between groups.
  
  
  CONCLUSIONS
  Balloon-expandable TAVI in patients with a mildly calcified aortic valve was not associated with increased risk of valve embolization or mortality. We demonstrated high device success and lower rates of PVR for these patients. These findings suggest that in patients with evidence of haemodynamically severe AS at echocardiography, the presence of low ACVS at CT should not preclude the consideration of TAVI.
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Yigal
authors.initials: Y
authors.lastname: Abramowitz
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.affiliation: University Institute of Cardiology and Pneumology of Québec, Laval University Québec, Québec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kashif
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kazuno
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Maeno
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kawamori
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Geeteshwar
authors.initials: G
authors.lastname: Mangat
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Friedman
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome
keywords: TAVI; TAVR; transcatheter aortic valve replacement; valvular calcification