Aortic annulus dimensions and leaflet calcification from contrast MSCT predict the need for balloon post-dilatation after TAVI with the Medtronic CoreValve prosthesis

Abstract

Dense aortic leaflet calcification measured on contrast MSCT discerned well the need for balloon post-dilatation after TAVI with an MCS for significant PAR. Non-contrast MSCT may no longer be needed to quantify aortic root calcium before TAVI.

Timing, Predictive Factors, and Prognostic Value of Cerebrovascular Events in a Large Cohort of Patients Undergoing Transcatheter Aortic Valve Implantation

“…Balloon postdilation is used in about one fourth of the patients after valve prosthesis implantation, with the objective of reducing residual aortic regurgitation secondary to paravalvular leaks. [27][28][29] Preliminary data suggested an increase in CVEs with balloon postdilation, 17 and the results of the present study confirm that the further stretching of the calcified native valve during balloon postdilation is independently associated with a Ͼ2-fold risk of CVEs immediately or within the first few hours after the procedure. Balloon postdilation increases the interaction between the stent frame of the valve prosthesis and the native aortic valve, which might indeed favor the dislodgment of calcific particles from the native valve.…”

Extent and distribution of calcification of both the aortic annulus and the left ventricular outflow tract predict aortic regurgitation after transcatheter aortic valve replacement

“…Rosenhek . Several studies have identified calcification of the aortic valve as an independent predictor of aortic regurgitation, the need for post-dilation, the need for pacemaker implantation, and the risk of annulus rupture in patients undergoing TAVR 1,2,[7][8][9][10]15,16 . While these findings are well established for the overall extent of valve calcification, little is known about the spatial distribution of calcifications within the different levels of the aortic root, including Overall calcification grade Prevalence of moderate/severe AR Overall calcification grade Prevalence of moderate/severe AR …”

Multislice computer tomography (MSCT) for the optimisation of transcatheter aortic valve implantation (TAVI)

“…(39) Another study of 110 patients who received the MCS and where post-dilatation was performed in 11 cases found that the need for balloon post-dilatation was associated with larger annulus diameter, a lower ratio of prosthesis to annulus size and the degree of calcification of the aortic root or leaflets. (51) In that study the ability to discriminate the need for balloon post-dilatation was poor for the prosthesis to annulus ratio (area under a ROC curve 0.3), moderate for annulus dimensions (area under ROC curve 0.67) and excellent for calcification (area under ROC curve >0.8). (51) These data indicate that calcification is the most-important determinant of significant PAR and the need for post-dilatation and may, in future, lead to the testing of new procedural strategies intended to reduce PAR in patients known to have very dense aortic root calcification.…”

“…(51) In that study the ability to discriminate the need for balloon post-dilatation was poor for the prosthesis to annulus ratio (area under a ROC curve 0.3), moderate for annulus dimensions (area under ROC curve 0.67) and excellent for calcification (area under ROC curve >0.8). (51) These data indicate that calcification is the most-important determinant of significant PAR and the need for post-dilatation and may, in future, lead to the testing of new procedural strategies intended to reduce PAR in patients known to have very dense aortic root calcification.…”