“Device landing zone” calcification, assessed by MSCT, as a predictive factor for pacemaker implantation after TAVI

Latsios, George; Gerckens, Ulrich; Buellesfeld, Lutz; Mueller, Ralf; John, Daniel; Yuecel, Seyrani; Syring, Joerg; Sauren, Barthel; Grube, Eberhard

doi:10.1002/ccd.22563

Cited by 135 publications

(58 citation statements)

References 22 publications

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“…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 …”

Section: Discussionmentioning

confidence: 99%

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

Buellesfeld

Stortecky²,

Heg³

et al. 2014

EuroIntervention

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Aims: We sought to analyse local distribution of aortic annulus and left ventricular outflow tract (LVOT) calcification in patients undergoing transcatheter aortic valve replacement (TAVR) and its impact on aortic regurgitation (AR) immediately after device placement. Methods and results:A group of 177 patients with severe aortic stenosis undergoing multislice computed tomography of the aortic root followed by TAVR were enrolled in this single-centre study. Annular and LVOT calcifications were assessed per cusp using a semi-quantitative grading system (0: Conclusions: Calcifications of the aortic annulus and LVOT are frequent in patients undergoing TAVR, and both the distribution and the severity of calcifications appear to be independent predictors of aortic regurgitation after device implantation. KEYWORDS• aortic annulus • calcification • outflow tract • transcatheter aortic valve replacement

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Section: Discussionmentioning

confidence: 99%

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

Buellesfeld

Stortecky²,

Heg³

et al. 2014

EuroIntervention

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“…This finding is in line with the underlying hypothesis that specific approach-related parameters might outperform a rather global risk categorization in terms of outcome prediction after TA-TAVI. Besides the LVOT-aorta angle, obviously representing a key anatomic parameter in TA procedures, for example the calcification of the device landing zone has been shown to predict unfavorable procedural outcome in terms of paravalvular leak [16] and postoperative pacemaker dependency [17]. Similarly, the total aortic calcification burden has been recently described as an integrative predictor of mortality after TAVI [8].…”

Section: Discussionmentioning

confidence: 99%

Predicting Device Success and Early Clinical Outcome after Transapical Aortic Valve Implantation

Donndorf¹,

Fries²,

Glass³

et al. 2016

J Clin Trials

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Objective: Pre-procedural evaluation of aortic valve patients is based on the prediction of perioperative risk for a conventional aortic valve replacement (AVR) utilizing standardized risk scores. However, in in the era of transcatheter aortic valve implantation (TAVI) the specific prediction of procedural outcome of an interventional approach seems of growing importance. We aimed to isolate patient-and approach-related factors, predicting procedural outcome of transapical aortic valve implantation (TA-TAVI), especially focusing on parameters not included in standard risk scores (e.g. BMI, intracardiac anatomy, preoperative NT-proBNP).Methods: A cohort of 60 patients suffering from severe aortic stenosis and receiving TA-TAVI at our institution was analyzed (mean age was 77.7 ± 6.3 years, 50% male). All patients exhibited a high risk for conventional AVR (EuroScorelog ≥ 20 or porcelain aorta) and were scheduled for a TA approach using an Edwards Sapien valve following heart-team discussion. Prior the procedure, all patients underwent multi-slice computed tomography examination. In order to evaluate the procedural and clinical outcome after TA-TAVI, three endpoints were defined: More than mild postoperative paravalvular leak (PVL), postoperative mean transvalvular gradient > 14 mmHg and a composite endpoint of 30-day mortality, stroke and myocardial infarction. For isolation of outcome predictors, fourteen different potential predictors were included into primary univariate regression analyses, seven of which entered subsequent multivariate analyses.Results: A BMI ≥ 30 was found in multivariate logistic regression to double the risk for both more than mild PVL and higher postoperative transvalvular gradients, however without reaching statistical significance (OR 2.57 95% CI 0.69-9.52; p=0.157 and OR 2.32 95% CI 0.57-9.45; p=0.242, respectively). Male gender and COPD were both associated with a decreased risk for elevated postoperative gradients. Of the analyzed approach-related parameters, especially a LVOT-aorta angle <120° was associated with an increased risk of the composite end-point p=0.059). Furthermore preoperative NT-proBNP levels <400 ng/ml were found to predict a trend towards higher postoperative transvalvular gradients p=0.246). Conclusion:Standardized risk scores for conventional AVR are limited in terms of predicting the early outcome of TAVI procedures. The current study provides evidence that specific parameters such as the LVOT-aorta angle are likely to improve outcome prediction of patients undergoing TAVI procedures.

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“…(55,57) Whether aortic root calcification is associated with pacemaker requirement is controversial. (58,59) Iatrogenic membranous VSD Iatrogenic membranous VSD is uncommon after TAVI but may have adverse consequences. (41,60) A case report described the occurrence of iatrogenic VSD following post-dilatation of the TAVI prosthesis with a relatively oversized balloon in a patient with an unusually long ventricular membranous septum.…”

Section: Device Dislodgementmentioning

confidence: 99%

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

Schultz

Jaegere

2017

SAHJ

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Multislice computer tomography (MSCT) for the optimisation of transcatheter aortic valve implantation (TAVI) and 3-D TEE can evaluate all anatomical aspects of the aortic root. (6)(7)(8) MSCT is particularly attractive for the evaluation of anatomy because it provides the user with a 3-D virtual representation that can be viewed from any angle or cut-plane after acquisition. What follows is a review of the role of MSCT pre-and post-TAVI. DIAGNOSIS OF SEVERE AORTIC STENOSISThe diagnosis of severe aortic stenosis is typically based on demonstrated that the LVOT is oval shaped, a fact which cannot be appreciated on 2-D echocardiography. (10,12,13,) In 3 separate studies the assumption of circularity of the LVOT was abandoned when using the continuity equation and instead the LVOT area measured on MSCT was used to replace the LVOT diameter from TTE for the calculation of AVA. (14,15,16)

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“Device landing zone” calcification, assessed by MSCT, as a predictive factor for pacemaker implantation after TAVI

Abstract: Calcium amount in the CoreValve DLZ in combination with clinical data could predict the need for post TAVI PM implantation.

Cited by 135 publications

References 22 publications

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

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

Predicting Device Success and Early Clinical Outcome after Transapical Aortic Valve Implantation

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

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