Impact of severe left ventricular outflow tract calcification on device failure and short-term mortality in patients undergoing TAVI

Jochheim, David; Deseive, Simon; Gschwendtner, Sarah; Bischoff, Bernhard; Jochheim, Sarah; Hausleiter, Sebastian; Zadrozny, Magda; Baquet, Moritz; Tesche, Christian; Maßberg, Steffen; Mehilli, Julinda; Hausleiter, Jörg

doi:10.1016/j.jcct.2019.07.004

Cited by 25 publications

(22 citation statements)

References 22 publications

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“…The most important lesson from those trials is that the surgical risk may affect the perioperative and mid-term survival of sAVR as well as the mid-term survival of TAVR patients but not the perioperative survival of the latter. The anatomical risk on the degree and distribution of calcification as well as the presence of a bicuspid valve or left ventricular outflow tract (LVOT) calcifications has been associated with inferior results in TAVR 34 – 36 . This knowledge became more evident during the evolution of TAVR and patients with high anatomical risk conditions have been excluded from randomization.…”

Section: Discussionmentioning

confidence: 99%

Aortic valve function post-replacement of severe aortic stenosis by transcatheter procedure versus surgery: a systematic review and metanalysis

Khalil

Ignatiuk

Erdem

et al. 2021

Sci Rep

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Transcatheter aortic valve replacement (TAVR) has shown to reduce mortality compared to surgical aortic valve replacement (sAVR). However, it is unknown which procedure is associated with better post-procedural valvular function. We conducted a meta-analysis of randomized clinical trials that compared TAVR to sAVR for at least 2 years. The primary outcome was post-procedural patient-prosthesis-mismatch (PPM). Secondary outcomes were post-procedural and 2-year: effective orifice area (EOA), paravalvular gradient (PVG) and moderate/severe paravalvular leak (PVL). We identified 6 trials with a total of 7022 participants with severe aortic stenosis. TAVR was associated with 37% (95% CI [0.51–0.78) mean RR reduction of post-procedural PPM, a decrease that was not affected by the surgical risk at inclusion, neither by the transcatheter heart valve system. Postprocedural changes in gradient and EOA were also in favor of TAVR as there was a pooled mean difference decrease of 0.56 (95% CI [0.73–0.38]) in gradient and an increase of 0.47 (95% CI [0.38–0.56]) in EOA. Additionally, self-expandable valves were associated with a higher decrease in gradient than balloon ones (beta = 0.38; 95% CI [0.12–0.64]). However, TAVR was associated with a higher risk of moderate/severe PVL (pooled RR: 9.54, 95% CI [5.53–16.46]). All results were sustainable at 2 years.

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Section: Discussionmentioning

confidence: 99%

Aortic valve function post-replacement of severe aortic stenosis by transcatheter procedure versus surgery: a systematic review and metanalysis

Khalil

Ignatiuk

Erdem

et al. 2021

Sci Rep

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“…While previous studies attempted to associate specific locations of calcium deposits with procedural complications, we investigated the prognostic significance of volumetric quantification of vale tissue and its individual components. 33 Although aortic valve calcium was found to be associated with severe procedural complications, transcatheter aortic valves of second generations have been shown to remain less impacted by the extent of landing zone calcium. 34,35 We extend these observations by demonstrating that both total aortic tissue volume and the volume of non-calcific aortic valve tissue, but not calcific tissue alone, can predict 30-day MACEs (composite of cardiovascular death, all-stroke, and myocardial infarction) post-TAVI.…”

Section: Discussionmentioning

confidence: 99%

Non-calcific aortic tissue quantified from computed tomography angiography improves diagnosis and prognostication of patients referred for transcatheter aortic valve implantation

Grodecki

Tamarappoo

Huczek

et al. 2020

European Heart Journal - Cardiovascular Imaging

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Aims We aimed to investigate the role of aortic valve tissue composition from quantitative cardiac computed tomography angiography (CTA) in patients with severe aortic stenosis (AS) for the differentiation of disease subtypes and prognostication after transcatheter aortic valve implantation (TAVI). Methods and results Our study included 447 consecutive AS patients from six high-volume centres reporting to a prospective nationwide registry of TAVI procedures (POL-TAVI), who underwent cardiac CTA before TAVI, and 224 matched controls with normal aortic valves. Components of aortic valve tissue were identified using semi-automated software as calcific and non-calcific. Volumes of each tissue component and composition [(tissue component volume/total tissue volume) × 100%] were quantified. Relationship of aortic valve composition with clinical outcomes post-TAVI was evaluated using Valve Academic Research Consortium (VARC)-2 definitions. High-gradient (HG) AS patients had significantly higher aortic tissue volume compared to low-flow low-gradient (LFLG)-AS (1672.7 vs. 1395.3 mm3, P < 0.001) as well as controls (509.9 mm3, P < 0.001), but increased non-calcific tissue was observed in LFLG compared to HG patients (1063.6 vs. 860.2 mm3, P < 0.001). Predictive value of aortic valve calcium score [area under the curve (AUC) 0.989, 95% confidence interval (CI): 0.981–0.996] for severe AS was improved after addition of non-calcific tissue volume (AUC 0.995, 95% CI: 0.991–0.999, P = 0.011). In the multivariable analysis of clinical and quantitative computed tomography parameters of aortic valve tissue, non-calcific tissue volume [odds ratio (OR) 5.2, 95% CI 1.8–15.4, P = 0.003] and history of stroke (OR 2.6, 95% CI 1.1–6.5, P = 0.037) were independent predictors of 30-day major adverse cardiovascular event (MACE). Conclusion Quantitative CTA assessment of aortic valve tissue volume and composition can improve detection of severe AS, differentiation between HG and LFLG-AS in patients referred for TAVI as well as prediction of 30-day MACEs post-TAVI, over the current clinical standard.

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“…Although we did our best to collect all the data available to carry out pooled analyses, the observational studies included in this meta‐analysis had nonnegligible differences between them, which may have affected these results. For example, five studies reported their results with a mix of THVs 15‐17,19,20 . and four studies reported their results exclusively with balloon‐expandable THVs 18,21–23 …”

Section: Limitationsmentioning

confidence: 99%

“…For example, five studies reported their results with a mix of THVs. [15][16][17]19,20 and four studies reported their results exclusively with balloon-expandable THVs. 18,[21][22][23] We should also bear in mind that the populations in the studies are of advanced age (over 80 years) and it is highly likely that some overlap with the factor "frailty" not captured in the studies is present.…”

Section: Limitationsmentioning

confidence: 99%

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Impact of left ventricle outflow tract calcification on the outcomes of transcatheter aortic valve implantation: A study‐level meta‐analysis

Sá

Eynde

Malin

et al. 2022

Journal of Cardiac Surgery

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Objectives: To assess the impact of left ventricle outflow tract calcification (LVOT) on the outcomes of transcatheter aortic valve implantation (TAVI).Methods: Meta-analysis including studies published by October 2021. Primary endpoints were operative and 1-year mortality. The secondary endpoints were stroke, myocardial infarction, paravalvular leakage (PVL), new permanent pacemaker implantation (PPI), aortic annulus/root rupture.Results: Nine studies met our eligibility criteria, including a total of 4459 patients (1330 patients with significant LVOT calcification and 3129 patients without significant LVOT calcification). Pooled risk of operative death was higher in the group with significant LVOT calcification (odds ratio [OR]: 2.28; 95% confidence interval [CI]: 1.33-3.91; p < .001). Worse 1-year survival was observed in the group with

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Impact of severe left ventricular outflow tract calcification on device failure and short-term mortality in patients undergoing TAVI

Cited by 25 publications

References 22 publications

Aortic valve function post-replacement of severe aortic stenosis by transcatheter procedure versus surgery: a systematic review and metanalysis

Aortic valve function post-replacement of severe aortic stenosis by transcatheter procedure versus surgery: a systematic review and metanalysis

Non-calcific aortic tissue quantified from computed tomography angiography improves diagnosis and prognostication of patients referred for transcatheter aortic valve implantation

Impact of left ventricle outflow tract calcification on the outcomes of transcatheter aortic valve implantation: A study‐level meta‐analysis

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