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

Taishi Okuno1, Masahiko Asami2, Dik Heg3

  • 1Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: https://twitter.com/taishiokuno.

JACC. Cardiovascular Interventions
|August 9, 2020
PubMed

Insights

Moderate or severe left ventricular outflow tract (LVOT) calcification increases risks for transcatheter aortic valve replacement (TAVR) patients, including annular rupture and residual aortic regurgitation. Balloon-expandable valves showed higher annular rupture risk with LVOT calcification.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Left ventricular outflow tract (LVOT) calcification is linked to adverse outcomes post-transcatheter aortic valve replacement (TAVR).
  • Existing evidence is limited to observational studies with small sample sizes and incomplete assessment of transcatheter heart valve (THV) system effects.

Purpose of the Study:

  • To systematically evaluate the impact of LVOT calcification on procedural outcomes.
  • To assess the influence of LVOT calcification on device performance in contemporary THV systems.

Main Methods:

  • Retrospective analysis of a prospective single-center registry (SWISS TAVI Registry).
  • LVOT calcification assessed semiquantitatively: moderate/severe defined by ≥2 nodules, or 1 nodule >5 mm, or covering >10% of LVOT perimeter.
  • Included 1,635 patients undergoing TAVR between 2007 and 2018.

Main Results:

  • Moderate or severe LVOT calcification found in 24.9% of patients (407/1635).
  • Higher incidences of annular rupture (2.3% vs 0.2%), bailout valve-in-valve (VIV) implantation (2.9% vs 0.8%), and residual aortic regurgitation (AR) (11.1% vs 6.3%) in patients with moderate/severe LVOT calcification.
  • Balloon-expandable valves showed increased annular rupture risk (4.0% vs 0.4%) with moderate/severe LVOT calcification compared to other designs.

Conclusions:

  • Moderate or severe LVOT calcification increases risks for annular rupture, residual AR, and VIV implantation.
  • Risk of residual AR is consistent across different THV designs and generations.
  • Balloon-expandable valves are associated with a higher risk of annular rupture in the presence of moderate or severe LVOT calcification.
Abstract

Keywords:
balloon-expandable valveleft ventricular outflow tract calciummechanically expandable valveself-expanding valvetranscatheter aortic valve replacement

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