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DOI: 10.1055/s-0031-1297513
Aortic valve calcium symmetry and distribution to predict localisation of paravalvular leakage after TAVI
Objectives: Calcium distribution, topography and morphology in aortic valve stenosis may have an impact on the localisation of postprocedural paravalvular leakages (PVL) following transcatheter aortic valve implantation (TAVI).
Methods: Between 05/2005 and 03/2011 a total of 332 patients underwent either transapical (TA) or transvascular (TV) TAVI using the Edwards-SAPIENTM, SAPIEN-XTTM (Edwards Lifesciences, Irvine, CA), or the CoreValve ReValvingTM system (Medtronic, Irvine, CA). Aortic cusp and annular calcium distribution as well as aortic valve calcium symmetry were evaluated by preoperative tranesophageal echocardiography in a prospective, observational study. All patients showing mild to moderate PVL after TAVI were analysed. Commercial available image processing and analysing software were used to digitally evaluate all relevant calcific sections (calcification score 0–66; symmetry score 0–5) and were matched with the localization of the PVLs. Aortic valve insufficiency was graded by pressure half time.
Results: A total of 67 patients (82.0±6.2years, 62% female, mean logistic EuroSCORE 22.3±13.3%) were identified by transthoracic echocardiography with a mild-moderate PVL after TAVI (TV, n=52; TA, n=15). The mean calcification score was 40.3±8.0 with less calcification in the right non-coronary part (P<0.001) and mean symmetry score was 1.85±0.9. Mean pressure half-time was 428±131ms indicating moderate aortic regurgitation. As a result, the relation of aortic calcium symmetry and distribution to postprocedural PVL localisation was only 20.2% for TA and 26.2% for TV.
Conclusion: The present study shows that the localisation of a PVL after TAVI has just a very weak relation to the calcium symmetry and distribution of the diseased aortic valve and therefore remains unpredictable before TAVI.