Author + information
- Received August 26, 2009
- Revision received November 2, 2009
- Accepted November 5, 2009
- Published online February 1, 2010.
- Daniel John, MD,
- Lutz Buellesfeld, MD⁎ (, )
- Seyrani Yuecel, MD,
- Ralf Mueller, MD,
- Georg Latsios, MD,
- Harald Beucher, MD,
- Ulrich Gerckens, MD and
- Eberhard Grube, MD
- ↵⁎Reprint requests and correspondence:
Dr. Lutz Buellesfeld, HELIOS Heart Center Siegburg, Ringstrasse 49, 53721 Siegburg, Germany
Objectives The aim of this study was to assess the influence of amount and distribution of calcifications of the aortic valve and the left ventricular outflow tract on the acute procedural outcome of patients undergoing transcatheter aortic valve implantation (TAVI).
Background Transcatheter aortic valve implantation is a new percutaneous technique especially for elderly, high-risk patients with significant aortic valve stenosis (AS). After TAVI, post-interventional paravalvular aortic regurgitations (PAR) can occur, which is believed to be related partially to valve calcifications.
Methods We prospectively analyzed 100 symptomatic patients with severe AS scheduled for TAVI with the CoreValve ReValving (Medtronic, Minneapolis, Minnesota) prosthesis. In all patients, a native and contrast-enhanced multislice cardiac computed tomography was performed pre-interventionally. Calcification load of the valve and the adjacent outflow tract was estimated by the Agatston Score (AgS), and the amount and distribution of calcification was semi-quantitatively assessed and graded on a 1 to 4 scale (device “landing zone” calcification score [DLZ-CS]). Aortography was performed to evaluate the PAR pre-interventionally, after initial device release (PAR0) and after termination of the procedure (PAR1). Transthoracic echocardiography was performed 2 weeks after implantation (PAR2).
Results The AgS and DLZ-CS showed a significant correlation with the grade of PAR0 (AgS: r = 0.329, p = 0.001; DLZ-CS: r = 0.356, p < 0.001), PAR1 (AgS: r = 0.254, p = 0.011; DLZ-CS: r = 0.240, p = 0.016), and PAR2 (AgS: r = 0.341, p = 0.001; DLZ-CS: r = 0.300, p = 0.002). Both scores (AgS and DLZ-CS) showed a significant positive correlation (r = 0.858, p < 0.001).
Conclusions Calcification in the CoreValve device “landing zone” shows a significant positive correlation to PAR after TAVI. Furthermore, the need for “second maneuvers” (i.e., post-dilation after initial device release) can be predicted by these calcification scores (AgS and DLZ-CS).
Study devices have been provided by CoreValve. Drs. Gerckens and Grube are proctors for Medtronic/CoreValve. The first 2 authors contributed equally to this work.
- Received August 26, 2009.
- Revision received November 2, 2009.
- Accepted November 5, 2009.
- American College of Cardiology Foundation