Device Landing Zone Calcification and Its Impact on Post Procedural Paravalvular Leakage after Transcatheter Aortic Valve Implantation with Two Generations of Balloon-expandable Transcatheter Heart Valves

M. Linder; M. Seiffert; N. Schofer; F. Deuschl; G. Schoen; J. Schirmer; H. Treede; S. Blankenberg; H. Reichenspurner; U. Schaefer; L. Conradi

doi:10.1055/s-0036-1571488

The Thoracic and Cardiovascular Surgeon, Table of Contents

Device Landing Zone Calcification and Its Impact on Post Procedural Paravalvular Leakage after Transcatheter Aortic Valve Implantation with Two Generations of Balloon-expandable Transcatheter Heart Valves

M. Linder ¹, M. Seiffert ², N. Schofer ², F. Deuschl ², G. Schoen ³, J. Schirmer ¹, H. Treede ¹, S. Blankenberg ², H. Reichenspurner ¹, U. Schaefer ², L. Conradi ¹

¹University Heart Center Hamburg, Department of Cardiovascular Surgery, Hamburg, Germany
²University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
³University Medical Center Hamburg-Eppendorf, Department of Medical Biometry and Epidemiology, Hamburg, Germany

Abstract

Background: Calcification of the device landing zone is linked to residual paravalvular leakage (PVL) after transcatheter aortic valve implantation (TAVI). It is also known that residual more-than-mild PVL has an influence on clinical outcome. Our aim was to assess the device landing zone calcification and its impact of PVL with second (SXT) versus third-generation (S3) balloon-expandable SAPIEN prostheses.

Methods: Retrospective analysis of device landing zone calcification was performed in 413 consecutive patients with sufficient CT-quality. From January 2012 to August 2015, 155 patients were treated with the SXT (control group) and 258 patients with the S3 prosthesis (study group). Retrospective assessment of calcification pattern of the aortic root including the aortic valve (zone 1) and the left ventricular outflow tract (zone 2) was performed with the 3mensio Medical Imaging software (3mensio Medical ImagingBV, Bilthoven, NL). Primary endpoint was incidence of more-than-mild PVL at discharge.

Results: Both groups showed no differences in quantity and distribution of calcification of the device landing zone. Higher quantity of calcification was significantly predictive for post procedural PVL in both groups (zone 1: OR 1.28, p = 0.02; zone 2: OR 1.26, p = 0.02). Independently of preoperative amount and distribution of calcification, the study group had a significant lower rate of more-than-mild residual PVL than the control group (n = 7 (2.7%) versus n = 11 (7.0%); p = 0.04).

Conclusion: Calcification of the device landing zone was associated with higher incidence of residual more-than-mild PVL after TAVI in both groups, however using the SAPIEN 3 prosthesis showed independently of the calcification pattern significantly lower rates of more-than-mild PVL than the control group.