Location and Severity of Aortic Valve Calcium and Implications for Aortic Regurgitation After Transcatheter Aortic Valve Implantation

Ewe, See Hooi; Ng, Arnold C.T.; Schuijf, Joanne D.; Kley, Frank van der; Colli, Andrea; Palmen, Meindert; Weger, Arend de; Marsan, Nina Ajmone; Holman, Eduard R.; Roos, Albert de; Schalij, Martin J.; Bax, Jeroen J.; Delgado, Victoria

doi:10.1016/j.amjcard.2011.07.007

Cited by 199 publications

(124 citation statements)

References 22 publications

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“…There are multiple determinants of PVR, including device positioning and LVOT/ annulus/leaflet calcification. [41][42][43][44][45][46][47] Although the predictive value of annulus sizing is significant, it is unlikely that any method will yield a higher AUC than that shown in this and other studies. In addition, annulus sizing is not the only parameter used to determine THV size; transfemoral access, sinus effacement, sinus height, coronary ostial height, and LVOT anatomy are some of the other important considerations.…”

Section: Discussionmentioning

confidence: 48%

Aortic Annular Sizing Using a Novel 3-Dimensional Echocardiographic Method

Khalique

Kodali

Paradis

et al. 2014

Circ: Cardiovascular Imaging

147

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The goal of the current study is to compare a novel 3D-TEE method for annular assessment with MDCT measurements Background-Previous studies have shown cross-sectional 3-dimensional (3D) transesophageal echocardiographic (TEE) measurements to severely underestimate multidetector row computed tomographic (MDCT) measurements for the assessment of aortic annulus before transcatheter aortic valve replacement. This study compares annulus measurements from 3D-TEE using off-label use of commercially available software with MDCT measurements and assesses their ability to predict paravalvular regurgitation. Methods and Results-One hundred patients with severe, symptomatic aortic stenosis who had both contrast MDCT and 3D-TEE for annulus assessment before balloon-expandable transcatheter aortic valve replacement were analyzed. Annulus area, perimeter, and orthogonal maximum and minimum diameters were measured. Receiver operating characteristic analysis was performed with mild or greater paravalvular regurgitation as the classification variable. Three-dimensional TEE and MDCT cross-sectional perimeter and area measurements were strongly correlated (r=0.93-0.94; P<0.0001); however, the small differences (≤1%) were statistically significant (P=0.0002 and 0.0074, respectively). Discriminatory ability for ≥ mild paravalvular regurgitation was good for both MDCT (area under the curve for perimeter and area cover index=0.715 and 0.709, respectively) and 3D-TEE (area under the curve for perimeter and area cover index=0.709 and 0.694, respectively). Differences in receiver operating characteristic analysis between MDCT and 3D-TEE perimeter and area cover indexes were not statistically significant (P=0.15 and 0.35, respectively). Conclusions-Annulus

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Section: Discussionmentioning

confidence: 48%

Aortic Annular Sizing Using a Novel 3-Dimensional Echocardiographic Method

Khalique

Kodali

Paradis

et al. 2014

Circ: Cardiovascular Imaging

147

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“…The extent of native aortic valve calcification and its location has been repeatedly shown to be predictive of PVL post-TAVR with both the Edwards and CoreValve THV, 17,18,[37][38][39][40][41] because it impairs apposition and complete expansion of the THV by imposing an asymmetrical shape to the valve deployment area. Different studies have quantified calcification of the aortic root using different imaging techniques and scoring systems.…”

Section: Causes and Predictors Of Paravalvular Regurgitationmentioning

confidence: 99%

Paravalvular Aortic Leak After Transcatheter Aortic Valve Replacement

Lerakis

Hayek²,

Douglas³

2013

Circulation

197

128

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“…Thus, future studies will be needed to determine the optimal method for annular sizing to balance the minimization of PAR versus vascular injury. Beyond annular sizing and THV selection, some groups have shown that aortic valve calcification and its location of calcification correlates post-TAVR PAR 21,22 because exuberant calcium may result in a degree of nonapposition and incomplete expansion of the THV. These findings have not been consistent across series with higher correlation with self-expanding prostheses perhaps because of the lower radial force and conformability of the stent to the native annulus (Table 1).…”

Section: Leipsic Et Al Ct To Reduce Tavr Complications 599mentioning

confidence: 99%