Quantity and Location of Aortic Valve Complex Calcification Predicts Severity and Location of Paravalvular Regurgitation and Frequency of Post-Dilation After Balloon-Expandable Transcatheter Aortic Valve Replacement

Khalique, Omar; Hahn, Rebecca T.; Gada, Hemal; Nazif, Tamim; Vahl, Torsten; George, Isaac; Kalesan, Bindu; Forster, Molly; Williams, Mathew; Leon, Martin B.; Einstein, Andrew J.; Pulerwitz, Todd; Pearson, Gregory; Kodali, Susheel

doi:10.1016/j.jcin.2014.03.007

Cited by 195 publications

(141 citation statements)

References 35 publications

Supporting

Mentioning

124

Contrasting

Unclassified

Order By: Relevance

“…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.…”

mentioning

confidence: 99%

See 2 more Smart Citations

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

Maeno¹,

Abramowitz²,

Kazuno³

et al. 2017

Int. Heart J.

View full text Add to dashboard Cite

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)

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

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

Maeno¹,

Abramowitz²,

Kazuno³

et al. 2017

Int. Heart J.

View full text Add to dashboard Cite

show abstract

“…There are also a number of other determinates of PVR, such as annular and valvular calcification. 28 This analysis did not include consideration of the effect of aortic calcium on valvular regurgitation.…”

Section: Limitationsmentioning

confidence: 99%

Relationship of Annular Sizing Using Multidetector Computed Tomographic Imaging and Clinical Outcomes After Self-Expanding CoreValve Transcatheter Aortic Valve Replacement

Popma

Gleason

Yakubov

et al. 2016

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

T ranscatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement in patients deemed high risk or extreme risk for surgery.1-4 TAVR using the self-expanding CoreValve transcatheter heart valve (THV) was superior to medical therapy using an objective performance goal in patients at extreme risk for surgical aortic valve replacement 3 and associated with an improved survival compared with surgical aortic valve replacement in patients at increased risk for surgery. Background-Multidetector computed tomography is useful for determining the appropriate transcatheter heart valve (THV) size in patients with severe aortic stenosis who are suboptimal surgical candidates. The relationship between adherence to the recommended CoreValve sizing algorithm and clinical outcomes is not known. Methods and Results-We evaluated 1023 patients with severe aortic stenosis deemed high or extreme risk for surgery treated with the CoreValve THV. All patients underwent preprocedural multidetector computed tomography, and the scans were reviewed at a central analysis center using standardized software. Compliance to a recommended sizing algorithm was used to identify patients with below-range, in-range, and above-range THV sizing. A device annular sizing ratio (DAR) was also calculated based on the native annulus perimeter and perimeter of the selected THV. Clinical end points included the presence of paravalvular aortic regurgitation evaluated by an independent echocardiographic laboratory. Adherence to the sizing algorithm was highest with a 31-mm THV (92.6%) and lowest with the 23-mm THV (38.5%). Below-range sizing was associated with a higher rate of moderate or severe paravalvular aortic regurgitation (15.3%) than in-range (6.5%) or above-range (10.0%; P<0.001) sizing. Higher DARs were associated with lower rates of moderate or severe paravalvular aortic regurgitation: DAR ≤10%, 17.6%; DAR 10% to 15%, 9.9%; DAR 15% to 20%, 6.3%; and DAR >20%, 4.9%; P<0.001. There was no increase in clinical events associated with higher DARs. Conclusions-Adherence to a sizing algorithm guided by multidetector computed tomography resulted in lower rates of paravalvular aortic regurgitation after self-expanding transcatheter valve replacement without an increase in complications. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01240902.(Circ Cardiovasc Interv. 2016;9:e003282.

show abstract

“…[44][45][46] Reports of improved outcomes with the use of intraprocedural TEE 47 likely stem from the continuous imaging during the procedure and the rapid diagnosis of complications such as PVR 48 or even reduction in nephrotoxic contrast use. 49,50 Initial early TAVR randomized trials mandated the use of general anesthesia (GA) and TEE imaging for intraprocedural guidance 4,5 ; however, numerous recent reports of the safety of TAVR under monitored anesthetic care or CS 51,52 have resulted in the increasing use of this management protocol.…”

Section: Intraprocedural Imaging For Specific Valvular Interventions mentioning

confidence: 99%

Transcathether Valve Replacement and Valve Repair

Hahn

2016

Circulation Research

Self Cite

View full text Add to dashboard Cite

Transcatheter aortic valve replacement for treatment of aortic stenosis has now become an accepted alternative to surgical valve replacement for some patients. In addition, transcatheter mitral valve repair is also routinely used in high surgical risk patients with mitral regurgitation. Other transcatheter procedures are in rapid development. The current review attempts to summarize the procedures and echocardiographic imaging used for transcatheter valve replacement or valve repair.

show abstract

Quantity and Location of Aortic Valve Complex Calcification Predicts Severity and Location of Paravalvular Regurgitation and Frequency of Post-Dilation After Balloon-Expandable Transcatheter Aortic Valve Replacement

Cited by 195 publications

References 35 publications

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

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

Relationship of Annular Sizing Using Multidetector Computed Tomographic Imaging and Clinical Outcomes After Self-Expanding CoreValve Transcatheter Aortic Valve Replacement

Transcathether Valve Replacement and Valve Repair

Contact Info

Product

Resources

About