Incidence, timing, and predictors of valve dislodgment during TAVI with the medtronic corevalve system

Abstract

The incidence of periprocedural valve dislodgment was 18% in these series. Less aortic root calcification appeared the single independent predictor.

SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR)

“…44 The severity and location or aortic ring calcification may be related to annular rupture. Aortic valve calcification has also been speculated to be associated with increased risk for prosthesis dislodgement, 46 reported in 4%-18% of several series. 46,49,50 Possibly, calcification has a greater effect on postimplant paravalvular regurgitation with self-expanding prostheses than with balloonexpandable prostheses.…”

“…The presence of valvular calcifications may be of importance to ensure prosthesis anchorage and avoid dislodgement. 46 By contrast, excessive calcification may hamper the apposition of the prosthesis to the irregular surface of the aortic root and may leave gaps between the prosthetic frame and the native aortic root that favor the occurrence of paravalvular aortic regurgitation after implantation. 47,48 However, evidence about the presence of aortic valve calcification and the occurrence of paravalvular aortic regurgitation is controversial.…”

Timing, Predictive Factors, and Prognostic Value of Cerebrovascular Events in a Large Cohort of Patients Undergoing Transcatheter Aortic Valve Implantation

“…Valve dislodgment has been described mostly for the self-expandable CoreValve system; it is usually managed by pulling back the partially deployed valve through the aortic arch and descending aorta up to the 18F iliofemoral sheath. 33 Valve prosthesis embolization occurs mainly toward the ascending aorta; the valve prosthesis is usually removed up to the aortic arch or descending aorta with the use of an inflated balloon within the valve or by snaring the prosthesis stent frame. 34,35 All these maneuvers are associated with significant mechanical friction between the prosthesis frame and the aortic wall and are potentially highly thromboembolic.…”

Multislice computer tomography (MSCT) for the optimisation of transcatheter aortic valve implantation (TAVI)

“…(52) Predictors of intraprocedural device dislodgement, which required device retrieval and repeated implantation in the correct position, were investigated in one study of 98 patients. (53) Device dislodgement occurred in 18 of the patients and was associated with larger aortic valve area and a lower degree of aortic root calcification. In multivariate analysis an aortic root calcium threshold of <2 359 (Agatston score) was the only independent predictor for valve dislodgement (OR 3.1, 95% confidence interval 1.1 -8.8).…”

“…The authors proposed that, in patients with low levels of aortic root calcification device deployment during rapid pacing may be considered to avoid dislodgement during the deployment stage. (53) New conduction abnormalities or pacing requirement…”