Transcatheter aortic valve implantation with the Portico and Evolut R bioprostheses in patients with elliptic aortic annulus

Gorla, Riccardo; Marco, Federico De; Morganti, Simone; Finotello, Alice; Brambilla, Nedy; Testa, Luca; Agnifili, Mauro; Tusa, Maurizio; Auricchio, Ferdinando; Bedogni, Francesco

doi:10.4244/eij-d-19-00115

Cited by 14 publications

(9 citation statements)

References 5 publications

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“…This adds to the growing data on measurement of aortic valve calcium, which has already shown high levels of agreement between pre-surgery CT aortic valve calcium scores and ex-vivo calcium content using the volume scoring system (20). Commercially available software platforms (GE, Philips, Siemens, 3mensio) have also shown strong levels of agreement with comparable results for calcium scoring using the volume score (19). Terarecon was not included in this analysis and we believe this is the first study to demonstrate that Terarecon can be used for quantifying aortic valve calcium with good agreement between individual calcium leaflet scores and the total calcium score using the Agatston method.…”

Section: Discussionmentioning

confidence: 64%

“…We performed univariate and multivariate logistic regression to analyse the effect of the aortic valve leaflet calcium score on the risk for PVR and PPI. Because of the limited number of events of PVR, we adjusted for trans-catheter heart valve under sizing (dichotomous variable defined based on the manufacturer's CT derived perimeter recommended size and the actual implanted size) and eccentricity index of >0.25 (1 -dmin/dmax)(19) in the multivariate analysis. All statistical analyses were performed using STATA version 14 (StataCorp, TX, USA).…”

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confidence: 99%

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Association of individual aortic leaflet calcification on paravalvular regurgitation and conduction abnormalities with self-expanding trans-catheter aortic valve insertion

Mahon

Davies

Gambaro

et al. 2021

Quant Imaging Med Surg

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Background: Complication rates of paravalvular aortic regurgitation (PVR) and permanent pacemaker insertion remain high in patients undergoing trans-catheter aortic valve insertion for severe aortic stenosis.The spatial distribution of calcium between individual aortic valve leaflets, and its potential role in these complications is gaining interest. We aimed to assess the accuracy of individual aortic valve leaflet calcium quantification, and to determine its effect on the frequency of these complications.Methods: This was a retrospective study of 251 patients who underwent trans-catheter aortic valve insertion using the Evolut RTM valve. The off-line Terarecon software platform was used for Agatston scoring the short axis views.Results: There was a correlation between the sum of the individual leaflet and the total aortic valve calcium score. There was a univariate association between an increase [per 100 Agatston unit (AU)] in both right coronary leaflet (RCL) and left coronary leaflet (LCL) calcium with the risk of PVR. There was an association between an increase in LCL calcium score (per 100 AU) and need for post-implantation balloon aortic valvuloplasty (BAV). There was no association between individual leaflet calcification on the risk of permanent pacemaker insertion.Conclusions: This study supports the idea that a quantifiable and reproducible method of individual valve leaflet calcification score may serve as an independent risk factor for paravalvular regurgitation, beyond visual assessment of asymmetry. However, the same may not be true of spatial calcium distribution and permanent pacemaker implantation (PPI).

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Section: Discussionmentioning

confidence: 64%

mentioning

confidence: 99%

Association of individual aortic leaflet calcification on paravalvular regurgitation and conduction abnormalities with self-expanding trans-catheter aortic valve insertion

Mahon

Davies

Gambaro

et al. 2021

Quant Imaging Med Surg

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“…Among anatomical factors affecting device success (e.g., calcifications, elliptic aortic annulus, bicuspid valve), horizontal aorta poses significant anatomic and technical challenges to successful positioning and optimal deployment of the prosthesis during TAVI and extreme AA (i.e., >70 ) has been previously reported as absolute exclusion criterion for TAVI with a self-expanding (SE) device. [3][4][5] To date, there are conflicting data comparing SE (Corevalve-Evolut R) versus balloon-expanding (BE) devices (Sapien XT/Sapien 3)…”

Section: Introductionmentioning

confidence: 99%

Impact of aortic angle on transcatheter aortic valve implantation outcome with Evolut‐R, Portico, and Acurate‐NEO

Gorla

Marco

Garatti

et al. 2020

Cathet Cardio Intervent

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Objectives: To investigate paravalvular leak (PVL) and devices success rates according to aortic angle (AA) in patients undergoing transcatheter aortic valve implantation (TAVI) with three new-generation self-expanding devices. Background: The impact of aortic angle (AA) on TAVI device success and PVL rates is controversial. Methods: This retrospective study included 392 patients submitted to TAVI for severe aortic stenosis with Portico, Evolut-R and Acurate-NEO, and available AA measurements at computed tomography (CT) angiography. AA was calculated from the implantation projection and was defined as the angle between the plane of aortic annulus and an ideal horizontal plane. Aorta was defined horizontal if AA>57 (75th percentile). Results: In the horizontal group, the rates of moderate/severe PVL was higher in the Evolut-R group (20.8%), which was also characterized by a lower implant compared to that of Acurate-NEO, whereas device success was comparable among the three devices. AA was a significant predictor of moderate/severe PVLs (AUC 0.72, p = .002) only in the Evolut-R population. On multivariate analysis, calcium volume 850HU, bicuspid aortic valve, and implantation depth at the level of left coronary cusp were independent predictors of moderate/ severe PVL. On univariate analysis in the horizontal aorta population, implantation depth was confirmed among the most significant predictors of moderate/severe PVL. Conclusions: Despite comparable device success rates, horizontal aorta represented a technical challenge only in the Evolut-R subgroup, which showed higher rates of moderate/severe PVL than Portico and Acurate-NEO, and was associated with a low implant.

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“…An idealized aortic root model composed of three regions (annulus/LVOT, valsalva sinuses and ascending aorta) was conceived as previously reported [10]. Only the aortic root was considered, native leaflets were not taken into account in the simulation framework.…”

Section: Simulation Frameworkmentioning

confidence: 99%

“…Device success depends on several features, which are related either to the aortic root and valve anatomy (e.g., calcifications, aortic angulation) and technical aspects (e.g., oversizing, implantation depth) [8][9][10][11]. One of the anatomical factors that may be relevant to procedural success is the size and dimension of the annular and left ventricular outflow tract (LVOT) calcifications [8].…”

Section: Introductionmentioning

confidence: 99%

Impact of Nodular Calcifications in the Aortic Annulus and Left Ventricular Outflow Tract on TAVI Outcome with New-Generation Devices

Gorla¹,

Oliva²,

Poletti³

et al. 2022

Rev. Cardiovasc. Med.

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Background:The impact of nodular calcifications in left ventricular outlow tract (LVOT) and aortic annulus on the procedural outcome of transcatheter aortic valve implantation (TAVI) with new-generation devices is yet to be elucidated. Similarly, computational simulations may provide a novel insight into the biomechanical features of TAVI devices and their interaction with nodular calcifications. Methods: This retrospective single-center study included 232 patients submitted to TAVI with Evolut-R (53.4%), Portico (33.6%) and Lotus (13.0%) devices with available preoperative computed tomography (CT) angiography and evidence of nodular calcifications in aortic annulus and/or LVOT. Calcification severity was defined ≥moderate in presence of at least two nodules or one nodule ≤5 mm. Three virtual simulation models of aortic root presenting a nodular calcification of increasing size were implemented. Stress distribution, stent-root contact area and paravalvular orifice area were computed. Results: At least moderate calcifications were found in 123 (53.0%) patients, with no sex differences. Among the ≥moderate calcification group, lower device success rate was evident (87.8% vs. 95.4%; p = 0.039). Higher rates of ≥moderate paravalvular leak (PVL) (11.4% vs. 3.7%; p = 0.028) and vascular complications (9.8% vs. 2.8%; p = 0.030) were also observed. Among the Evolut-R group, higher rates of at ≥moderate PVL (12.1%) were observed compared to Portico (3.8%; p = 0.045) and Lotus (0.0%; p = 0.044) groups. Calcification of both annulus and LVOT (odds ratio [OR] 0.105; p = 0.023) were independent predictors of device success. On computational simulations, Portico exhibited homogeneous stress distribution by increasing calfications and overall a larger paravalvular orifice areas compared to Evolut-R and Lotus. Evolut-R showed higher values of average stress than Portico, although with a more dishomogeneous distribution leading to greater paravalvular orifice areas by severe calcifications. Lotus showed overall small paravalvular orifice areas, with no significant increase across the three models. Conclusions: At least moderate nodular calcifications in the annulus/LVOT region significantly affected TAVI outcome, as they were independent predictors of device success. Lotus and Portico seemed to perform better than Evolut-R as for device success and ≥moderate PVL. Computational simulations revealed unique biomechanical features of the investigated devices in terms of stent compliance and radial force.

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Transcatheter aortic valve implantation with the Portico and Evolut R bioprostheses in patients with elliptic aortic annulus

Cited by 14 publications

References 5 publications

Association of individual aortic leaflet calcification on paravalvular regurgitation and conduction abnormalities with self-expanding trans-catheter aortic valve insertion

Association of individual aortic leaflet calcification on paravalvular regurgitation and conduction abnormalities with self-expanding trans-catheter aortic valve insertion

Impact of aortic angle on transcatheter aortic valve implantation outcome with Evolut‐R, Portico, and Acurate‐NEO

Impact of Nodular Calcifications in the Aortic Annulus and Left Ventricular Outflow Tract on TAVI Outcome with New-Generation Devices

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