Impact of aortic valve calcification severity on device success after transcatheter aortic valve replacement

Int J Cardiovasc Imaging. 2020 Apr;36(4):731-740. doi: 10.1007/s10554-019-01759-7. Epub 2020 Jan 8.

Abstract

Aortic valvular calcium score (AVCS) can identify severe aortic stenosis (AS) and provide powerful prognostic information. In severe and symptomatic AS, patients can be referred for a transcatheter aortic valve replacement (TAVR). The aim of this study was to determine whether AVCS, measured on the preoperative contrast enhanced multislice computed tomography (MSCT), is associated with device success (DS), major adverse cardiac events (MACEs) and paravalvular leak (PVL) after TAVR. Three hundred and fifty-two consecutive patients who underwent TAVR with a preoperative standardised contrast enhanced MSCT were included in the study. Valvular calcification detection was defined by adding + 100 Hounsfield Unit (HU) to mean HU determined by a region of interest placed in the contrast enhanced ascending aorta. AVCS was then indexed to the aortic annulus surface (AVCSi). Endpoints were DS and 30-day MACE according to Valve Academic Research Consortium-2 consensus document, and moderate to severe PVL. DS was obtained for 305 patients. In multivariate analysis, AVCSi was negatively and independently associated with DS: OR = 0.99, 95% CI 0.99-0.99, p = 0.03. In the subgroup analysis, this association was particularly relevant with self-expanding prostheses [n = 151 (43%), p = 0.018] and in the cases of asymmetric calcium valvular distribution [n = 283 (80%), p 0.002]. There was no association between MACE and AVCS (p = 0.953) and AVCSi (p = 0.757). PVL was positively associated with AVCS (p < 0.001) and AVCSi (p < 0.001). In conclusion, in TAVR, AVCS, measured on preoperative contrast enhanced MSCT, is significantly associated with DS and PVL, but not with 30-day MACE. Its routine use could be relevant to appreciate success chances of TAVR.

Keywords: Aortic valve disease; CT scanning; Calcium scoring; Paravalvular leak; TAVR.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / pathology*
  • Aortic Valve / physiopathology
  • Aortic Valve / surgery*
  • Aortic Valve Insufficiency / diagnostic imaging
  • Aortic Valve Insufficiency / etiology
  • Aortic Valve Insufficiency / physiopathology
  • Aortic Valve Stenosis / diagnostic imaging
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / surgery*
  • Calcinosis / diagnostic imaging
  • Calcinosis / physiopathology
  • Calcinosis / surgery*
  • Echocardiography, Doppler
  • Female
  • Heart Valve Prosthesis*
  • Humans
  • Male
  • Multidetector Computed Tomography
  • Prosthesis Design
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Time Factors
  • Transcatheter Aortic Valve Replacement / adverse effects
  • Transcatheter Aortic Valve Replacement / instrumentation*
  • Treatment Outcome

Supplementary concepts

  • Aortic Valve, Calcification of