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.

Binary alloy nanoparticles were fabricated by two combinatorial methods: (I) cosputtering from elemental targets into the ionic liquid 1-butyl-3-methylimidazolium bis­(trifluoromethylsulfonyl)­imide [Bmim]­[(Tf)2N] and (II) by mixing elemental nanoparticles after sputtering them separately into [Bmim]­[(Tf)2N]. Both methods lead to the formation of Au–Cu nanoparticles (2.3 nm for cosputtered, 3.6 nm for mixed), however with different resulting compositions: cosputtered nanoparticles show a composition range of Au80–90Cu20–10; mixing of Au- and Cu-loaded ionic liquids leads to the formation of Au75Cu25 nanoparticles. Annealing the binary nanoparticles at 100 °C shows that the mixed nanoparticles grow to sizes of 4.1 nm, whereas the cosputtered nanoparticles grow only to 3 nm.

The quantity of AVC calcium predicts residual PVR. Multivariable analysis identified LVOT calcium, pre-existing RBBB, and age > 82.7 years as independent predictors of PPI. Based on these risk factors, a patient's individual PPI risk can be stratified ranging from 3.8 to 100%.

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