How valvular calcification can affect the outcomes of transcatheter aortic valve implantation

Abstract

Introduction: In transcatheter aortic valve implantation (TAVI), assessment of aortic valve calcification is not as standardized as aortic annulus measurement. Aortic valve calcification is important for stable anchoring of the prosthesis to the aortic annulus. However, excessive aortic valve calcification is related to procedural complications. Areas covered: This review covers the methods to assess aortic valve calcification and the implications of aortic valve calcium burden for TAVI outcomes. We performed a systematic review of the literature in Pubmed and secondary sources. Furthermore, future perspectives on how to integrate aortic valve calcification assessment in the management of patients with aortic stenosis is discussed. Expert opinion: Thorough assessment of the aortic valve and aortic root components including aortic valve calcification is key in the planning of TAVI. Aortic valve calcification load, location and extension are important contributors to paravalvular regurgitation. Asymmetric calcification burden with greater calcification of the left-coronary cusp related to higher need of permanent pacemaker implantation. Patients with moderate and severe left ventricular outflow tract/subannular calcification are more susceptible to aortic annular rupture. Periprocedural dislodgement of calcium form cusps and commissures is one of the main reasons of coronary artery ostial occlusion during transcatheter aortic valve implantation.

Balloon‐expandable transcatheter heart valves for treatment of aortic valve stenosis in patients with large aortic annuli: Evaluation of deployment balloon overfilling strategies

“…Although sizing error is one of the most common reasons for valve migration in TAVI, 19 and theoretically all patients receiving TAVI in this series were exposed to sizing error due to significant valve undersizing, there is also agreement on importance of amount and distribution of aortic valve complex calcification on clinical efficacy in TAVI. While severe calcification is traditionally considered to be a predictor for significant postoperative PVL and PPI, 20,21 it is also well recognized from TAVI for pure aortic regurgitation that patients with no to mild calcifications of the aortic valve complex may still be safely treated if oversizing of THV is planned to avoid valve embolization. 22,23 Therefore, the herein presented results suggest that decision making regarding overfilling strategies in BE THV are a balance between risk of valve embolization and risk of residual hidden confounders may apply.…”

Risk factors and clinical effects of subclinical leaflet thrombosis after transcatheter aortic valve replacement

“…Because unremoved aortic valve calcification in TAVR is the characteristic of TAVR in contrast to SAVR, studies on the clinical effect of aortic valve calcium extent have been actively conducted. The aortic valve calcium extent is known to affect various poor outcome after TAVR, such as paravalvular leakage, stoke, coronary ostium occlusion and conduction abnormality ( 35 ). It is meaningful because this study firstly revealed the direct relation of aortic valve calcium extent with leaflet thrombosis.…”

Expert Consensus on Sizing and Positioning of SAPIEN 3/Ultra in Bicuspid Aortic Valves

“…The location of calcium predicts complications: calcification of the raphe(s) affects device expansion, and increases the risks of regurgitation, misplacement, and pacemaker requirement; calcium at the commissures may cause perforation; calcium at the tip of a leaflet risks coronary obstruction (although in most BAV patients spacious sinuses often protect against coronary occlusion). In addition, severe calcification in BAV with a tapered configuration confers a risk of Valsalva rupture [ 10 ].…”