Aortic valve calcification as a predictor of location and severity of paravalvular regurgitation after transcatheter aortic valve implantation

Ezra Y Koh; Kayan Y Lam; Navin R Bindraban; Riccardo Cocchieri; R Nils Planken; Karel T Koch; Jan Baan Jr; Bas A de Mol; Henk A Marquering

doi:10.1093/icvts/ivu413

Aortic valve calcification as a predictor of location and severity of paravalvular regurgitation after transcatheter aortic valve implantation

Interact Cardiovasc Thorac Surg. 2015 Mar;20(3):345-50. doi: 10.1093/icvts/ivu413. Epub 2014 Dec 8.

Authors

Ezra Y Koh¹, Kayan Y Lam², Navin R Bindraban³, Riccardo Cocchieri², R Nils Planken⁴, Karel T Koch³, Jan Baan Jr³, Bas A de Mol², Henk A Marquering⁵

Affiliations

¹ Department of Cardiothoracic Surgery, Academic Medical Centre, Amsterdam, Netherlands e.y.koh@amc.uva.nl.
² Department of Cardiothoracic Surgery, Academic Medical Centre, Amsterdam, Netherlands.
³ Department of Cardiology, Academic Medical Centre, Amsterdam, Netherlands.
⁴ Department of Radiology, Academic Medical Centre, Amsterdam, Netherlands.
⁵ Department of Radiology, Academic Medical Centre, Amsterdam, Netherlands Department of Biomedical Engineering and Physics, Academic Medical Centre, Amsterdam, Netherlands.

PMID: 25487234
DOI: 10.1093/icvts/ivu413

Abstract

Objectives: To determine whether the location of aortic valve calcium (AVC) influences the location of paravalvular regurgitation (PR). PR is an adverse effect of transcatheter aortic valve implantation (TAVI) with a negative effect on long-term patient survival. The relationship between AVC and the occurrence of PR has been documented. However, the relationship between the distribution of AVC and the location of PR is still sparsely studied. The purpose of this study was to correlate severity and location of AVC with PR in patients treated with TAVI.

Methods: Fifty-six consecutive patients who underwent transaortic or transapical TAVI and had preoperative computed tomography scans were included in this retrospective study. The volume, mass and location of AVC was determined and compared between patients with and without PR using a non-parametric t-test. Postoperative echocardiography was performed to determine the presence and location of PR, which was associated with the cusp with highest AVC using a χ(2) test.

Results: Valve deployment was successful in all 56 patients. PR was present in 38 patients (68%) after TAVI. There was a non-significantly higher volume of AVC in the PR group [214 (70-418) vs 371 (254-606) cm(3), P = 0.15]. AVC mass was significantly higher in patients with PR than in patients without PR [282 (188-421) vs 142 (48-259) mg, respectively, P = 0.043]. The location of PR was determined in 36 of these patients. Of these 36 patients, PR occurred at the cusp with the highest AVC in 20 patients (56%, χ(2) P = 0.030).

Conclusions: In our population, PR was associated with greater AVC mass. Moreover, the location of PR was associated with the cusp with the highest amount of AVC.

Keywords: Aortic valve calcium; Paravalvular regurgitation; Transcatheter aortic valve implantation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Aortic Valve / pathology*
Aortic Valve / surgery
Aortic Valve Insufficiency / diagnosis
Aortic Valve Insufficiency / epidemiology
Aortic Valve Insufficiency / etiology*
Aortic Valve Stenosis / complications*
Aortic Valve Stenosis / diagnosis
Aortic Valve Stenosis / surgery
Calcinosis / complications*
Calcinosis / diagnosis
Calcinosis / surgery
Cardiac Catheterization / methods*
Echocardiography, Transesophageal
Female
Heart Valve Prosthesis / adverse effects*
Humans
Incidence
Male
Netherlands / epidemiology
Postoperative Complications*
Retrospective Studies
Risk Factors
Severity of Illness Index
Tomography, X-Ray Computed
Transcatheter Aortic Valve Replacement / adverse effects*
Treatment Outcome

Supplementary concepts

Aortic Valve, Calcification of