The impact of calcium volume and distribution in aortic root injury related to balloon-expandable transcatheter aortic valve replacement

Hansson, Nicolaj C.; Nørgaard, Bjarne Linde; Barbanti, Marco; Nielsen, Niels Erik; Yang, Tae Hyun; Tamburino, Corrado; Dvir, Danny; Jilaihawi, Hasan; Blanke, Phillip; Makkar, Raj; Latib, Azeem; Colombo, Antonio; Tarantini, Giuseppe; Raju, Rekha; Wood, David; Andersen, Henning; Ribeiro, Henrique Barbosa; Kapadia, Samir; Min, James K.; Feuchtner, Gudrun; Gurvitch, Ronen; Alqoofi, Faisal; Pelletier, Marc; Ussia, Gian Paolo; Napodano, Massimo; Brito, Fábio Sândoli de; Kodali, Susheel; Pache, Gregor; Cánovas, Sergio; Berger, Adam; Murphy, Darra; Svensson, Lars G.; Rodés‐Cabau, Josep; Leon, Martin B.; Webb, John G.; Leipsic, Jonathon

doi:10.1016/j.jcct.2015.04.002

Cited by 98 publications

(38 citation statements)

References 34 publications

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“…Prosthesis valve area was derived according to the geometrical rule: A=π(d/2) 2 , where d is the labeled prosthesis size. Aortic annulus eccentricity index was calculated as 1-(minimal diameter/maximal diameter) based on MDCT annular measurements [11].…”

Section: 8%mentioning

confidence: 99%

Risk factors for paravalvular leak after transcatheter aortic valve replacement

Pollari

Dell’Aquila

Söhn

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Objective. To assess risk factors for paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) in a large single-center cohort, including measurement of aortic valve calcification using a reproducible method. Methods. We retrospectively analyzed preoperative contrast-enhanced multidetector computed tomography (MDCT) scans of patients who underwent TAVI in our center between 2009 and 2016. Calcium volume was calculated for each aortic cusp in the aortic valve (AV), left ventricular outflow tract (LVOT) and device-landing zone (DLZ). Results. Overall, 539 patients were included in the study (Edwards SapienXT, n=192; Edwards Sapien3, n=206; Medtronic CoreValve EvolutR, n=44; Symetis Acurate, n=97). Median calcium volume in the DLZ was 757 mm 3 , with no significant differences among the four prosthesis groups. None of the patients had severe PVL. The overall incidence of mild-to-moderate PVL was 15.8% (95% CI: 12.8-19.1%). On multivariate logistic regression, DLZ calcification (p=0.00006; OR for an increase of 100 mm 3 1.08; 95% CI: 1.04-1.13) and use of the CoreValve (p=0.0028; OR 4.1; 95% CI: 1.6-10 with SapienXT as reference) prosthesis were found to be associated with ≥mild PVL. In contrast, degree of oversizing (p=0.002; OR 0.97; 95% CI: 0.95-0.99), and use of Sapien3 (p=0.00005; OR 0.23; 95% CI: 0.11-0.47 with SapienXT as reference) were associated with a lower incidence of ≥mild PVL. Conclusions. Aortic calcification volume in the DLZ is associated with residual PVL after TAVI. When taking calcification into account, the balloon-expandable prosthesis Sapien3 seems to be associated with a lower incidence of PVL.

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Section: 8%mentioning

confidence: 99%

Risk factors for paravalvular leak after transcatheter aortic valve replacement

Pollari

Dell’Aquila

Söhn

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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“…used by Hansson et al32 and based on prior work by Dey et al33 and Mylonas et al 34 .In such a model, a volume of interest is placed in a uniform normal blood pool region at the level of the left main ostium and a patient-specific calcium detection threshold is calculated using a software which uses a fitted Gaussian curve. Such models are excellent research tools but are not widely available for implementation into daily clinical practice.…”

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confidence: 99%

Practical determination of aortic valve calcium volume score on contrast-enhanced computed tomography prior to transcatheter aortic valve replacement and impact on paravalvular regurgitation: Elucidating optimal threshold cutoffs

Bettinger

Khalique

Krepp

et al. 2017

Journal of Cardiovascular Computed Tomography

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“…26 A higher burden of LVOT calcification, especially when extending into the LVOT in the non-coronary cusp, has also been associated with aortic root injury during TAVI with balloon-expandable valves. 27 Moderate to severe annular calcification is also an independent predictor of ≥mild PVL. 28 Although not directly associated with annular rupture, annular calcification with ≥mild PVL usually prompts balloon postdilatation.…”

Section: Anatomicalmentioning

confidence: 98%

Annular Rupture During Transcatheter Aortic Valve Implantation: Predictors, Management and Outcomes

Coughlan

Kiernan

Mylotte

et al. 2018

Interventional Cardiology Review

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Transcatheter aortic valve implantation (TAVI) is the treatment of choice in patients with symptomatic severe aortic stenosis who are either inoperable or at high risk for conventional surgical aortic valve replacement. Recent data have also shown favourable outcomes in patients deemed to be at intermediate operative risk, which expands the application of this novel technology. Despite its success, TAVI has been associated with rare life-threatening complications. Of these, aortic annular rupture is considered to be the most devastating. Advances in pre-procedural screening and patient selection have reduced the incidence of annular rupture. When this complication occurs, early recognition and prompt management are essential. This article is intended to provide a comprehensive review of the predictors, management and clinical outcomes of aortic annular rupture.

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The impact of calcium volume and distribution in aortic root injury related to balloon-expandable transcatheter aortic valve replacement

Cited by 98 publications

References 34 publications

Risk factors for paravalvular leak after transcatheter aortic valve replacement

Risk factors for paravalvular leak after transcatheter aortic valve replacement

Practical determination of aortic valve calcium volume score on contrast-enhanced computed tomography prior to transcatheter aortic valve replacement and impact on paravalvular regurgitation: Elucidating optimal threshold cutoffs

Annular Rupture During Transcatheter Aortic Valve Implantation: Predictors, Management and Outcomes

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