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Relation between calcium burden, echocardiographic stent frame eccentricity and paravalvular leakage after corevalve
Luigi F M Di Martino1,2, Osama I I Soliman1,3, Lennart van Gils1
1Department of Cardiology, Ospedali Riuniti, Università degli Studi di Foggia, Foggia, Italy.
Insights
Aortic annulus calcification correlates with eccentric CoreValve shape, increasing paravalvular aortic leakage (PVL) after transcatheter aortic valve implantation (TAVI). PVL location is linked to specific eccentric stent frame shapes.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Background:
- Paravalvular aortic leakage (PVL) is a significant complication following transcatheter aortic valve implantation (TAVI).
- The relationship between native aortic root calcium burden, stent frame eccentricity, and PVL has not been previously investigated.
Purpose of the Study:
- To investigate the association between aortic root calcium burden, CoreValve stent frame eccentricity, and the incidence and severity of PVL after TAVI.
Main Methods:
- Retrospective analysis of 223 patients undergoing TAVI with a Medtronic CoreValve System.
- Assessment of echocardiographic stent frame eccentricity and PVL severity (VARC-2 criteria).
- Correlation analysis between aortic annulus calcification (Agatston score) and stent frame eccentricity.
Main Results:
- Stent frame eccentricity was observed in 35% of patients and significantly correlated with aortic root calcium burden (ρ = 0.241, P = 0.003).
- A significant correlation was found between stent frame eccentricity and PVL severity (ρ = 0.525, P < 0.0001).
- Specific eccentric stent frame shapes were associated with the location of PVL.
Conclusions:
- Aortic annulus calcification is linked to an eccentric shape of the CoreValve prosthesis post-TAVI.
- This eccentric shape contributes to increased PVL, with PVL localization influenced by the specific stent frame eccentricity.
Aims:
Paravalvular aortic leakage (PVL) after transcatheter aortic valve implantation (TAVI) is a complication with potentially severe consequences. The relation between native aortic root calcium burden, stent frame eccentricity and PVL was not studied before.
Methods And Results:
Two-hundred-and-twenty-three consecutive patients with severe aortic stenosis who underwent TAVI with a Medtronic CoreValve System© and who had available pre-discharge transthoracic echocardiography were studied. Echocardiographic stent inflow frame eccentricity was defined as major-minor diameter in a short-axis view >2 mm. PVL was scored according to the updated Valve Academic Research Consortium (VARC-2) recommendations. In a subgroup of 162 (73%) patients, the calcium Agatston score was available. Stent frame eccentricity was seen in 77 (35%) of patients. The correlation between the Agatston score and stent frame eccentricity was significant (ρ = 0.241, P = 0.003). Paravalvular leakage was absent in 91 cases (41%), mild in 67 (30%), moderate in 51 (23%), and severe in 14 (6%) cases. The correlation between stent frame eccentricity and PVL severity was significant (ρ = 0.525, P < 0.0001). There was a relation between particular eccentric stent frame shapes and the site of PVL.
Conclusion:
Calcification of the aortic annulus is associated with a subsequent eccentric shape of the CoreValve prosthesis. This eccentric shape results in more PVL, with the localization of PVL related to the shape of stent frame eccentricity.