Impact of Left Ventricular Outflow Tract Calcification on Procedural Outcomes After Transcatheter Aortic Valve Replacement.

Okuno, Taishi; Asami, Masahiko; Heg, Dik; Lanz, Jonas; Praz, Fabien; Hagemeyer, Daniel; Brugger, Nicolas; Gräni, Christoph; Huber, Adrian; Spirito, Alessandro; Räber, Lorenz; Stortecky, Stefan; Windecker, Stephan; Pilgrim, Thomas (2020). Impact of Left Ventricular Outflow Tract Calcification on Procedural Outcomes After Transcatheter Aortic Valve Replacement. JACC. Cardiovascular Interventions, 13(15), pp. 1789-1799. Elsevier 10.1016/j.jcin.2020.04.015

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OBJECTIVES

This study aimed to systematically assess the importance of left ventricular outflow tract (LVOT) calcification on procedural outcomes and device performances with contemporary transcatheter heart valve (THV) systems.

BACKGROUND

LVOT calcification has been associated with adverse clinical outcomes after transcatheter aortic valve replacement (TAVR). However, the available evidence is limited to observational data with modest numbers and incomplete assessment of the effect of the different THV systems.

METHODS

In a retrospective analysis of a prospective single-center registry, LVOT calcification was assessed in a semiquantitative fashion. Moderate or severe LVOT calcification was documented in the presence of 2 nodules of calcification, or 1 extending >5 mm in any direction, or covering >10 % of the perimeter of the LVOT.

RESULTS

Among 1,635 patients undergoing TAVR between 2007 and 2018, moderate or severe LVOT calcification was found in 407 (24.9%). Patients with moderate or severe LVOT calcification had significantly higher incidences of annular rupture (2.3% vs. 0.2%; p < 0.001), bailout valve-in-valve implantation (2.9% vs. 0.8%; p = 0.004), and residual aortic regurgitation (11.1% vs. 6.3%; p = 0.002). Balloon-expandable valves conferred a higher risk of annular rupture in the presence of moderate or severe LVOT calcification (4.0% vs. 0.4%; p = 0.002) as compared with the other valve designs. There was no significant interaction of valve design or generation and LVOT calcification with regard to the occurrence of bailout valve-in-valve implantation and residual aortic regurgitation.

CONCLUSIONS

Moderate or severe LVOT calcification confers increased risks of annular rupture, residual aortic regurgitation, and implantation of a second valve. The risk of residual aortic regurgitation is consistent across valve designs and generations. (SWISS TAVI Registry; NCT01368250).

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Asami, Masahiko; Heg, Dierik Hans; Lanz, Jonas; Praz, Fabien; Hagemeyer, Daniel Philipp Alfons; Brugger, Nicolas Jacques; Gräni, Christoph; Huber, Adrian Thomas; Spirito, Alessandro; Räber, Lorenz; Stortecky, Stefan; Windecker, Stephan and Pilgrim, Thomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1876-7605

Publisher:

Elsevier

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

10 Aug 2020 14:12

Last Modified:

11 Aug 2020 10:43

Publisher DOI:

10.1016/j.jcin.2020.04.015

PubMed ID:

32763071

Uncontrolled Keywords:

balloon-expandable valve left ventricular outflow tract calcium mechanically expandable valve self-expanding valve transcatheter aortic valve replacement

BORIS DOI:

10.7892/boris.145677

URI:

https://boris.unibe.ch/id/eprint/145677

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