Impact of device landing zone calcification patterns on paravalvular regurgitation after transcatheter aortic valve replacement with different next-generation devices

• Published in: Open heart Vol. 7; no. 1; p. e001164
• Main Authors: Mauri, Victor, Frohn, Thomas, Deuschl, Florian, Mohemed, Kawa, Kuhr, Kathrin, Reimann, Andreas, Körber, Maria Isabel, Schofer, Niklas, Adam, Matti, Friedrichs, Kai, Kuhn, Elmar W, Scholtz, Smita, Rudolph, Volker, Wahlers, Thorsten C W, Baldus, Stephan, Mader, Navid, Schäfer, Ulrich, Rudolph, Tanja K
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 10.05.2020; BMJ Publishing Group
• Series: Original research
• Subjects: Aged; Aged, 80 and over; Aortic Valve - diagnostic imaging; Aortic Valve - pathology; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - etiology; Aortic Valve Insufficiency - physiopathology; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Asymmetry; Calcification; Calcinosis - diagnostic imaging; Calcinosis - physiopathology; Calcinosis - surgery; Cardiovascular disease; Chronic obstructive pulmonary disease; Data analysis; Female; Germany; Heart Valve Prosthesis; Hemodynamics; Humans; Male; Pacemakers; Patients; Prostheses; Prosthesis Design; Recovery of Function; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Surgery; Time Factors; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - instrumentation; Treatment Outcome; Valvular Heart Disease; Variables; Germany; United States > US; prosthetic heart valves; aortic valve disease; calcium
• ISSN: 2053-3624; 2398-595X; 2053-3624
• DOI: 10.1136/openhrt-2019-001164

ObjectiveResidual paravalvular regurgitation (PVR) has been associated to adverse outcomes after transcatheter aortic valve replacement (TAVR). This study sought to evaluate the impact of device landing zone (DLZ) calcification on residual PVR after TAVR with different next-generation transcatheter heart valves.Methods642 patients underwent TAVR with a SAPIEN 3 (S3; n=292), ACURATE neo (NEO; n=166), Evolut R (ER; n=132) or Lotus (n=52). Extent, location and asymmetry of DLZ calcification were assessed from contrast-enhanced CT imaging and correlated to PVR at discharge.ResultsPVR was ≥moderate in 0.7% of S3 patients, 9.6% of NEO patients, 9.8% of ER patients and 0% of Lotus patients (p<0.001), and these differences remained after matching for total DLZ calcium volume. The amount of DLZ calcium was significantly related to the degree of PVR in patients treated with S3 (p=0.045), NEO (p=0.004) and ER (p<0.001), but not in Lotus patients (p=0.698). The incidence of PVR ≥moderate increased significantly over the tertiles of DLZ calcium volume (p=0.046). On multivariable analysis, calcification of the aortic valve cusps, LVOT calcification and the use of self-expanding transcatheter aortic valve implantation (TAVI) prostheses emerged as predictors of PVR.ConclusionsThe susceptibility to PVR depending on the amount of calcium was mainly observed in self-expanding TAVI prostheses. Thus, DLZ calcification is an important factor to be considered in prosthesis selection for each individual patient, keeping in mind the trade-off between PVR reduction, risk of new pacemaker implantation and unfavourable valve ha emodynamics.