Device landing zone calcification and its impact on residual regurgitation after transcatheter aortic valve implantation with different devices

Seiffert, Moritz; Fujita, Buntaro; Avanesov, Maxim; Lunau, Clemens; Schön, Gerhard; Conradi, Lenard; Prashovikj, E.; Scholtz, Smita; Börgermann, Jochen; Scholtz, Werner; Schäfer, Ulrich; Lund, Gunnar; Ensminger, Stephan; Treede, Hendrik

doi:10.1093/ehjci/jev174

Cited by 89 publications

(52 citation statements)

References 27 publications

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“…15 The present study demonstrated that excessive calcification of the native aortic valve was independently associated with significant PVR after TAVI. This was also demonstrated by Seiffert et al 16 in a recent study including 537 patients treated with different models of TAVI bioprostheses (SAPIEN XT, JenaValve, Symetis, CoreValve, and Engager). Larger AVC load, particularly at the level of the LVOT inferior to the annulus (coefficient 0.146, 95% CI 0.038 to 0.253, p ¼ 0.008), and type of bioprosthesis (CoreValve; coefficient 0.368, 95% CI 0.233 to 0.503, p <0.001) were independently associated with PVR after TAVI.…”

Section: Discussionsupporting

confidence: 68%

Impact of Different Iterations of Devices and Degree of Aortic Valve Calcium on Paravalvular Regurgitation After Transcatheter Aortic Valve Implantation

Kong

Rosendael

Kley

et al. 2016

The American Journal of Cardiology

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The iterations of the SAPIEN prosthesis might impact the incidence and grade of paravalvular regurgitation (PVR). The aim of this study was to assess the impact of iterations of balloon-expandable valves (SAPIEN, SAPIEN XT, and SAPIEN 3) and degree of aortic valve calcification (AVC) on the severity of PVR after transcatheter aortic valve implantation (TAVI). Comprehensive echocardiographic examinations and multidetector computed tomography (MDCT) were performed in 272 patients (127 men, 81 ± 7 years old, logistic EuroScore of 21 ± 13%) who underwent TAVI with 23- and 26-mm balloon-expandable valves. The degree of AVC was assessed with MDCT. PVR grade was assessed with echocardiography. The cover index was calculated as (prosthesis area - MDCT annulus area)/prosthesis area. SAPIEN, SAPIEN XT, and SAPIEN 3 prostheses were implanted in 103 patients (38%), 105 patients (38.5%), and 64 patients (23.5%), respectively. Significant PVR (≥moderate) occurred in 14%, 10%, and 0% of patients receiving the SAPIEN, SAPIEN XT, and SAPIEN 3, respectively (p = 0.010). Across the groups, the aortic annulus size, degree of calcification, and cover index were comparable. Larger burden of AVC was independently associated with significant PVR (odds ratio 3.48, p = 0.006) after adjusting for age, body surface area, gender, aortic annulus area, cover index, and prosthesis iteration. SAPIEN 3 was associated with lower frequency of significant PVR (odds ratio 0.31, p = 0.002). In conclusion, the incidence of significant PVR significantly decreased over time with improvement in valve design. SAPIEN 3 was associated with less significant PVR after TAVI independently of the AVC burden.

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Section: Discussionsupporting

confidence: 68%

Impact of Different Iterations of Devices and Degree of Aortic Valve Calcium on Paravalvular Regurgitation After Transcatheter Aortic Valve Implantation

Kong

Rosendael

Kley

et al. 2016

The American Journal of Cardiology

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“…It was previously found to be associated with increased PVL or PD rates, and annulus injury only following BE-THV implantations. [7][8][9]11,12) Previous studies also demonstrated that there is reduced rates of PVL or PD following XT compared to CV TAVI. [4][5][6] Most of these previous studies included different grades of aortic valve calcification but did not evaluate association with DLZ calcification.…”

Section: Discussionmentioning

confidence: 99%

“…The upper LVOT region was defined as the cross-sectional region 2 mm inferior to the annular plane (Figure 1). 7,9,11,12) After excluding patients with the absence of up- per LVOT calcification (252 patients), previous bioprosthesis (45 patients), and patients with poor CT imaging quality (8 patients), a total of 174 patients were included in the final analysis. These patients were divided into two groups according to valve design.…”

Section: Methodsmentioning

confidence: 99%

“…4) Furthermore, calcium in the aortic-valvular complex (AVC) is a well-known predictor of PVL, PD, and annulus injury following TAVI. [7][8][9][10][11] Importantly, device landing zone (DLZ) calcification has been shown to be a strong predictor of PVL, PD, annulus injury, and new PPMI after XT or CV implantations. 7,[10][11][12] It was particularly found to be related to PVL after BE-or SE-TAVI 7) and to predict aortic root injury following BE-TAVI, 11) if DLZ calcification was located inferior to the annulus region.…”

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confidence: 99%

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Transcatheter Aortic Valve Implantation With Different Valve Designs for Severe Device Landing Zone Calcification

Maeno¹,

Abramowitz²,

Kazuno³

et al. 2017

Int. Heart J.

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SummarySevere device landing zone calcification (DLZ-CA) predicted paravalvular leak (PVL) and post-dilatation (PD) after transcatheter aortic valve implantation (TAVI). The aim of this study was to determine the influence of DLZ-CA on PVL or PD rates after SAPIEN XT (XT) versus CoreValve (CV).We analyzed patients undergoing TAVI who had severe DLZ-CA. Severe DLZ-CA defined the upper left ventricular outflow tract calcification; the cross-sectional region 2 mm inferior to the annular plane. PVL was evaluated at 30-days using transthoracic echocardiography. Overall, 133 patients had XT-TAVI and the remaining 41 patients had CV-TAVI. Two patients had annulus injury in the XT group (oversizing 20.2% and 20.5% for two XT cases). PD was less frequently performed in the XT group (34.1% versus 12.8%; P = 0.002), but PVL rates were similar between both groups (42.1% versus 41.5% for the XT and CV groups, respectively; P = 0.94). Importantly, excessive oversizing or the degree of filling volume was not associated with decreased PVL after XT-TAVI (P = non-significant for all). On multivariate analysis, CV-TAVI was found to be one of the independent predictors of need for PD (Odds ratio 3.63, 95% confidence interval 1.55 to 8.53, P = 0.003).In the setting of severe DLZ-CA, XT and CV have similar rates of PVL but XT had less need for PD. Excessive oversizing with XT carries a risk of root injury which could be further increased by DLZ-CA. (Int Heart J 2017; 58: 56-62)

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“…The amount of calcium in the TAVI device landing zone, defined as a volume or Agatston units, is a predictor of residual PVL [60,61].…”

Section: Patient Screening and Qualification To Tavimentioning

confidence: 99%

Transcatheter aortic valve implantation. Expert Consensus of the Association of Cardiovascular Interventions of the Polish Cardiac Society and the Polish Society of Cardio-Thoracic Surgeons, approved by the Board of the Polish Cardiac Society…

et al. 2017

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Device landing zone calcification and its impact on residual regurgitation after transcatheter aortic valve implantation with different devices

Abstract: Calcification of the device landing zone, particularly if located inferior to the annulus, was independently associated with residual AR after TAVI with all evaluated THV; however, the incidence of paravalvular leakage differed significantly between the devices implanted.

Cited by 89 publications

References 27 publications

Impact of Different Iterations of Devices and Degree of Aortic Valve Calcium on Paravalvular Regurgitation After Transcatheter Aortic Valve Implantation

Impact of Different Iterations of Devices and Degree of Aortic Valve Calcium on Paravalvular Regurgitation After Transcatheter Aortic Valve Implantation

Transcatheter Aortic Valve Implantation With Different Valve Designs for Severe Device Landing Zone Calcification

Transcatheter aortic valve implantation. Expert Consensus of the Association of Cardiovascular Interventions of the Polish Cardiac Society and the Polish Society of Cardio-Thoracic Surgeons, approved by the Board of the Polish Cardiac Society…

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