Relation between calcium burden, echocardiographic stent frame eccentricity and paravalvular leakage after corevalve transcatheter aortic valve implantation

Martino, Luigi Di; Soliman, Osama Ibrahim Ibrahim; Gils, Lennart van; Vletter, Wim B.; Mieghem, Nicolas Van; Ren, Ben; Galema, Tjebbe W.; Schultz, Carl; Jaegere, Peter P.T. de; Geleijnse, Marcel L.

doi:10.1093/ehjci/jex009

Cited by 30 publications

(29 citation statements)

References 20 publications

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“…Though statistical significance was lost, this trend persisted regardless of BAV performance/omission. Such a finding is unsurprising, given that distortion of the stent as a result of asymmetrical calcium deposition across AV cusps has been highlighted as the most significant contributor to PVL and that significant leaflet asymmetry was observed for both groups in the present study. Other studies, including the large‐scale, observational UK TAVI registry, have also found BAV to be unrelated to the rate of significant residual PVL .…”

Section: Discussionmentioning

confidence: 56%

Degree of valve calcification in patients undergoing transfemoral transcatheter aortic valve implantation with and without balloon aortic valvuloplasty: Findings from the multicenter EASE‐IT TF registry

Butter

Okamoto

Schymik

et al. 2019

Cathet Cardio Intervent

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Aims We aimed to assess whether the level of aortic root calcification is associated with BAV performance/omission during transcatheter aortic valve implantation (TAVI), and to explore related outcomes. Methods and results EASE‐IT TF was a prospective, observational, multicenter registry of patients undergoing TF‐TAVI with the Edwards SAPIEN 3, with or without BAV predilation. Valvular calcification was quantified from pre‐procedural multi‐slice computed tomography images and compared between BAV and no BAV patients. Data for 178 patients (55 BAV; 123 no BAV) were analyzed. There were no significant differences between groups in terms of regional/leaflet sector calcification volumes, maximum asymmetry between the different leaflet sectors, or total calcification scores. Overall, a greater‐than‐average leaflet calcification volume was independently predictive of ≥mild PVL (OR: 5.116; 95% CI: 1.042–38.35) and the need for post‐dilation (OR: 3.592; 95% CI: 1.173–12.14). The latter effect was abated in patients with BAV (OR: 1.837; 95% CI: 0.223–18.00) and intensified in those without BAV (OR: 5.575; 95% CI: 1.114–38.74). No other BAV‐dependent effects of calcification on outcomes were observed. Conclusions In the majority of transfemoral valve implantations, calcification does not appear to be the main driving factor in the decision to perform/omit BAV. Predilation may be valuable for reducing post‐dilation requirements in patients only with a greater degree of leaflet calcification.

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Section: Discussionmentioning

confidence: 56%

Degree of valve calcification in patients undergoing transfemoral transcatheter aortic valve implantation with and without balloon aortic valvuloplasty: Findings from the multicenter EASE‐IT TF registry

Butter

Okamoto

Schymik

et al. 2019

Cathet Cardio Intervent

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“…The association between eccentricity index assessed by MDCT and PVR was first described by Delgado et al [18]. This relation has also been described in vitro [25] and recently, Di Martino et al [26] observed association between calcium score, prosthesis eccentricity and subsequent PVR, however the evaluation of eccentricity was made with TTE, a technique that due to its two-dimensional nature has more limitations to consistently assess geometric morphology. This is the first study to demonstrate independent association between calcium burden, eccentricity evaluated by MDCT and PVR in a cohort of patients undergoing TAVR with either self-expanding and balloon-expandable prosthesis.…”

Section: Geometry and Paravalvular Regurgitationmentioning

confidence: 84%

Comparison of self‐expanding and balloon‐expandable transcatheter aortic valves morphology and association with paravalvular regurgitation: Evaluation using multidetector computed tomography

Almeida

Ferreira

Fonseca

et al. 2017

Cathet Cardio Intervent

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“…As the quantity and asymmetry of aortic valve calcification predict the severity of post-procedural PVL, [39][40][41][42][43][44] compared with direct TAVI with balloon-expandable valves. 18,27 Of note, valve repositioning during implantation of newer self-expanding devices could arguably represent a form of mild predilatation; however, the relative role of this step with respect to pre-BAV is currently unknown.…”

Section: Paravalvular Leakagementioning

confidence: 99%

Predilatation Prior to Transcatheter Aortic Valve Implantation: Is it Still a Prerequisite?

Pagnesi

Baldetti

Sole

et al. 2017

Interventional Cardiology Review

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Predilatation has been historically considered a mandatory step before transcatheter aortic valve implantation (TAVI) since it facilitates valve crossing and prosthesis delivery, ensures optimal valve expansion and improves hemodynamic stability during valve deployment. However, as a result of procedural evolution over time, direct TAVI (without pre-implantation balloon aortic valvuloplasty) has emerged as an interesting option to simplify the procedure and to avoid potential valvuloplasty-related complications. Several real-world retrospective studies and one small randomised study have shown that direct TAVI (with both self-expanding and balloon-expandable prostheses) is feasible, safe and associated with outcomes similar to standard TAVI with pre-implantation balloon aortic valvuloplasty. In the absence of high-quality, robust evidence, the current review aims to discuss the advantages and disadvantages of omitting predilatation prior to TAVI.

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Relation between calcium burden, echocardiographic stent frame eccentricity and paravalvular leakage after corevalve transcatheter aortic valve implantation

Abstract: Calcification of the aortic annulus is associated with a subsequent eccentric shape of the CoreValve prosthesis. This eccentric shape results in more PVL, with the localization of PVL related to the shape of stent frame eccentricity.

Cited by 30 publications

References 20 publications

Degree of valve calcification in patients undergoing transfemoral transcatheter aortic valve implantation with and without balloon aortic valvuloplasty: Findings from the multicenter EASE‐IT TF registry

Degree of valve calcification in patients undergoing transfemoral transcatheter aortic valve implantation with and without balloon aortic valvuloplasty: Findings from the multicenter EASE‐IT TF registry

Comparison of self‐expanding and balloon‐expandable transcatheter aortic valves morphology and association with paravalvular regurgitation: Evaluation using multidetector computed tomography

Predilatation Prior to Transcatheter Aortic Valve Implantation: Is it Still a Prerequisite?

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