Association of aortic valve calcification severity with the degree of aortic regurgitation after transcatheter aortic valve implantation.
ABSTRACT This study sought to examine a possible relationship between the severity of aortic valve calcification (AVC), the distribution of AVC and the degree of aortic valve regurgitation (AR) after transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS).
57 patients (22 men, 81 ± 5 years) with symptomatic AS and with a logistic EuroSCORE of 24 ± 12 were included. 38 patients (67%) received a third (18F)-generation CoreValve® aortic valve prosthesis, in 19 patients (33%) an Edwards SAPIEN™ prosthesis was implanted. Prior to TAVI dual-source computed tomography for assessment of AVC was performed. To determine the distribution of AVC the percentage of the calcium load of the most severely calcified cusp was calculated. After TAVI the degree of AR was determined by angiography and echocardiography. The severity of AR after TAVI was related to the severity and distribution of AVC.
There was no association between the distribution of AVC and the degree of paravalvular AR after TAVI as assessed by angiography (r = -0.02, p = 0.88). Agatston AVC scores were significantly higher in patients with AR grade ≥ 3 (5055 ± 1753, n = 3) than in patients with AR grade < 3 (1723 ± 967, p = 0.03, n = 54). Agatston AVC scores > 3000 were associated with a relevant paravalvular AR and showed a trend for increased need for second manoeuvres. There was a significant correlation between the severity of AVC and the degree of AR after AVR (r = 0.50, p < 0.001).
Patients with severe AVC have an increased risk for a relevant AR after TAVI as well as a trend for increased need for additional procedures.
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ABSTRACT: Transcatheter aortic valve implantation has been performed by several groups, most of them either specializing on the transapical (surgeons) or the percutaneous femoral transarterial approach (cardiologists). We achieved both transapical and percutaneous transcatheter valve implantation by a surgical team in a hybrid suite. Since June 2007, 137 patients (n=78 female, mean age 81+/-7 years) underwent transcatheter aortic valve implantation (n=109 transfemoral, n=3 via subclavian artery, n=2 directly through ascending aorta, n=23 transapical) with the CoreValve (n=114) or the Edwards Sapien (n=23) prosthesis. Thirty-day mortality was 12.4% in this patient cohort. One hundred and eight patients (78.8%) are alive at a mean follow-up of 97+/-82 days. Pacemaker implantation due to postoperative AV block was performed in 27 patients (19.7%), and 7 patients (5.1%) sustained neurological events. Patients improved in NYHA class (from 3.1+/-0.3 to 1.9+/-0.5, p<0.001) and in self-assessed health state (from 55+/-17% to 68+/-16%, p<0.001) at one-month follow-up. Echocardiographic assessment revealed excellent hemodynamic function of the prostheses with a mean aortic gradient (MAG) of 11.9+/-4.4 mmHg and an effective orifice area (EOA) of 1.6+/-0.4 cm(2) at discharge and a MAG of 11.0+/-4.2 mmHg and an EOA of 1.6+/-0.3 cm(2) at six months FU. Transcatheter aortic valve implantation has become an alternative technique for the treatment of aortic stenosis with reasonable short- and mid-term results at our institution. With the opportunity to treat aortic stenosis by conventional surgical valve replacement and transapical and percutaneous transcatheter procedures, the technique of lowest risk for the individual patient can be chosen and performed by one team.European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 03/2009; 35(4):615-20; discussion 620-1. · 2.40 Impact Factor
- Journal of the American Society of Echocardiography 08/2003; 16(7):777-802. · 4.28 Impact Factor