Incidence, timing, and predictors of valve dislodgment during TAVI with the medtronic corevalve system

• Published in: Catheterization and cardiovascular interventions Vol. 79; no. 5; pp. 726 - 732
• Main Authors: Van Mieghem, Nicolas M., Schultz, Carl J., van der Boon, Robert MA, Nuis, Rutger-Jan, Tzikas, Apostolos, Geleijnse, Marcel L., van Domburg, Ron T., Serruys, Patrick W., de Jaegere, Peter PT
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.04.2012
• Subjects: Aged; Aged, 80 and over; aortic stenosis; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Cardiac Catheterization - adverse effects; Cardiac Catheterization - methods; Cohort Studies; Confidence Intervals; Female; Follow-Up Studies; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Humans; Incidence; Intraoperative Complications - diagnosis; Intraoperative Complications - epidemiology; Male; Multivariate Analysis; Netherlands; Odds Ratio; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Predictive Value of Tests; Prosthesis Design; Prosthesis Failure - trends; Retrospective Studies; Risk Assessment; Survival Rate; TAVI; Time Factors; Treatment Outcome; Ultrasonography; VALV; valvular heart disease
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.23275

Objectives: To determine the incidence, timing and predictors of periprocedural valve dislodgment with the Medtronic Corevalve System (MCS). Background: Periprocedural valve dislodgment may occur during transcatheter aortic valve implantation (TAVI). Methods: Ninety‐eight consecutive patients underwent TAVI with the MCS after a comprehensive baseline assessment including invasive angiography, echocardiography, and Multi‐Slice Computed Tomography (MSCT). The invasive monitoring charts and angiographic studies of all TAVI procedures were reviewed to determine the incidence and timing of valve dislodgment. Results: Valve dislodgment occurred in 18 patients. Patients with valve dislodgment had a larger Aortic Valve Area (0.76 ± 0.25 cm2 vs. 0.61 ± 0.19 cm2, P = 0.007), lower mean transaortic gradient (37.65 ± 14.62 mm Hg vs. 47.11 ± 16.08 mm Hg, P = 0.03) and significantly less aortic root calcification (Agatston score median 1951 AU (IQR, 799–3103) vs. 3289 AU (IQR 2097–4481), P = 0.016). A lower aortic root calcium score (Agatston score < 2359 AU) was the single independent predictor for valve dislodgment (OR 3.10, 1.09–8.84). After valve dislodgment, the valve could be successfully retrieved and implanted in the proper anatomic location in all cases. Valve dislodgment was associated with a lower incidence of post‐procedural AR ≥ 2 (11.1% vs. 34.6%, P = 0.05). There were no relevant procedural or clinical implications to valve dislodgment. Conclusions: The incidence of periprocedural valve dislodgment was 18% in these series. Less aortic root calcification appeared the single independent predictor. © 2011 Wiley Periodicals, Inc.