Predictors of calcification distribution in severe tricuspid aortic valve stenosis

Abstract

We investigated aortic valve calcification (AVC) distribution and predictors for leaflet calcification patterns in patients with severe tricuspid aortic valve stenosis undergoing transcatheter aortic valve replacement (TAVR). Patients undergoing routine multi-sliced computed tomography (MSCT) for procedural planning were enrolled. MSCT data were transferred to a dedicated workstation for evaluation (3mensio Structural Heart™, Pie Medical Imaging BV, Maastricht, The Netherlands) and analyzed. Participants were separated into asymmetrical (AC) and symmetrical (SC) leaflet calcification and potential predictors for calcification distribution were identified with univariate and multivariate regression analysis. 567 Participants with severe tricuspid AS were divided into asymmetrical (AC, n = 443; 78.1%) and symmetrical (SC, n = 124; 21.9%) AVC. In AC, the non-coronary cusp was the most calcified cusp (n = 238; 57.7%). SC is more common in females (AC/SC: 49.2% vs. 67.7%; p < 0.0001). AVC was more severe in patients with AC, who also have larger aortic root dimensions. Multivariate analysis depicted, inter alia, left ventricular outflow tract (LVOT) calcification < 25 Agatston units (OR 1.81 [1.09–3.00], p = 0.021), a mean pressure gradient < 36 mmHg (OR 1.77 [1.03–3.05], p = 0.039), and an annulo-apical angle > 67° (OR 1.68 [1.00–2.80], p = 0.049) as predictors for SC, although with only moderate predictive value. Data from this retrospective analysis indicate that SC occurs more frequently in females. The cumulative leaflet calcification burden is higher in patients with AC, who also present with larger aortic root dimensions. The predictive value for prominent calcification of different aortic valve cusps in AC patients was only low to moderate.Trial registration number: NCT01805739.

Risk factors and clinical effects of subclinical leaflet thrombosis after transcatheter aortic valve replacement

“…Although in the present study, under-expansion could not be directly evaluated, under-expansion was presumed due to a smaller post-procedure EOA value in the leaflet thrombosis patients. The leaflet sections where thickening occurred were mostly in the sequence of NCC-RCC-LCC, which was the same order reported in a prior study ( 29 ) and the same order shown to have significant calcium ( 30 ). Regional under-expansion of stent was reportedly associated with leaflet thrombosis in a study by Fuchs A et al and a post-mortem study ( 29 , 31 ).…”

Presencia de regurgitaciones moderadas o graves luego del implante percutáneo de la válvula aórtica con la estrategia de “Cusp Overlap”

“…La presencia de RPV se ha relacionado con la calcificación valvular y su distribución, que generalmente es asimétrica, más importante en la valva y seno no coronariano en la mayoría de los pac. (15) En diferentes estudios se analizó la presencia de calcio y su volumen en la zona de implante (16,17) y se demostró que la asimetría de la calcificación se relaciona con RPV. (18) Además, algunos autores analizaron la presencia de calcio en el tracto de salida del ventrículo izquierdo.…”

Mild Paravalvular Leak May Pose an Increased Thrombogenic Risk in Transcatheter Aortic Valve Replacement (TAVR) Patients-Insights from Patient Specific In Vitro and In Silico Studies

“…With the extension of TAVR to younger patients, rates of subclinical leaflet thickening have been increasing [8][9][10]. Many studies [5,6] have shown rates of leaflet thrombosis are linked to unfavorable TAVR deployment parameters such as eccentric deployments [11] or reduced valve performance due to heavy patient calcification [12], as well as anatomical features such as large sinus of Valsalva leading to increased stagnation [13].…”