Clinical Research
Correlation of Device Landing Zone Calcification and Acute Procedural Success in Patients Undergoing Transcatheter Aortic Valve Implantations With the Self-Expanding CoreValve Prosthesis

https://doi.org/10.1016/j.jcin.2009.11.015Get rights and content
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Objectives

The aim of this study was to assess the influence of amount and distribution of calcifications of the aortic valve and the left ventricular outflow tract on the acute procedural outcome of patients undergoing transcatheter aortic valve implantation (TAVI).

Background

Transcatheter aortic valve implantation is a new percutaneous technique especially for elderly, high-risk patients with significant aortic valve stenosis (AS). After TAVI, post-interventional paravalvular aortic regurgitations (PAR) can occur, which is believed to be related partially to valve calcifications.

Methods

We prospectively analyzed 100 symptomatic patients with severe AS scheduled for TAVI with the CoreValve ReValving (Medtronic, Minneapolis, Minnesota) prosthesis. In all patients, a native and contrast-enhanced multislice cardiac computed tomography was performed pre-interventionally. Calcification load of the valve and the adjacent outflow tract was estimated by the Agatston Score (AgS), and the amount and distribution of calcification was semi-quantitatively assessed and graded on a 1 to 4 scale (device “landing zone” calcification score [DLZ-CS]). Aortography was performed to evaluate the PAR pre-interventionally, after initial device release (PAR0) and after termination of the procedure (PAR1). Transthoracic echocardiography was performed 2 weeks after implantation (PAR2).

Results

The AgS and DLZ-CS showed a significant correlation with the grade of PAR0 (AgS: r = 0.329, p = 0.001; DLZ-CS: r = 0.356, p < 0.001), PAR1 (AgS: r = 0.254, p = 0.011; DLZ-CS: r = 0.240, p = 0.016), and PAR2 (AgS: r = 0.341, p = 0.001; DLZ-CS: r = 0.300, p = 0.002). Both scores (AgS and DLZ-CS) showed a significant positive correlation (r = 0.858, p < 0.001).

Conclusions

Calcification in the CoreValve device “landing zone” shows a significant positive correlation to PAR after TAVI. Furthermore, the need for “second maneuvers” (i.e., post-dilation after initial device release) can be predicted by these calcification scores (AgS and DLZ-CS).

Key Words

calcification
procedural success
transcatheter aortic valve implantation

Abbreviations and Acronyms

AgS
Agatston score
AR
aortic regurgitation
AS
aortic valve stenosis
AVC
aortic valve calcification
CT
computed tomography
DLZ
device landing zone
DLZ-CS
device landing zone calcification score
LVOT
left ventricular outflow tract
MSCT
multislice computed tomography
PAR
paravalvular aortic regurgitation
PAR0
angiographic aortic regurgitation assessment immediately after device deployment
PAR1
angiographic aortic regurgitation assessment at the end of the procedure
PAR2
transthoracic echocardiography evaluation of the regurgitation grade 2 weeks after the procedure
TAVI
transcatheter aortic valve implantation

Cited by (0)

Study devices have been provided by CoreValve. Drs. Gerckens and Grube are proctors for Medtronic/CoreValve. The first 2 authors contributed equally to this work.