Impact of left ventricular outflow tract calcium on valve geometry in self-expanding transcatheter aortic-valve

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Giorgio A Medranda1, Toby Rogers1,2, Michael Fuery1

  • 1Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|June 20, 2022
PubMed

Insights

Left ventricular outflow tract (LVOT) calcium can affect transcatheter heart valve (THV) geometry after transcatheter aortic valve replacement (TAVR). However, the Evolut PRO/PRO+ THV maintains circularity and function despite moderate/severe LVOT calcium.

Area of Science:

  • Cardiovascular Imaging and Intervention
  • Biomaterials and Medical Devices

Background:

  • Left ventricular outflow tract (LVOT) calcification presents challenges for contemporary transcatheter heart valves (THVs).
  • The degree and location of LVOT calcium can influence THV deployment, potentially altering flow dynamics and shear stress, which may accelerate THV degeneration.

Purpose of the Study:

  • To evaluate transcatheter heart valve (THV) geometry in relation to left ventricular outflow tract (LVOT) calcium burden.
  • To assess the impact of LVOT calcium on hemodynamics and outcomes following transcatheter aortic valve replacement (TAVR) with a self-expanding THV.

Main Methods:

  • Analysis of 107 patients from the EPROMPT registry (CoreValve Evolut Pro Prospective Registry) who underwent TAVR with CoreValve Evolut PRO/PRO+ THVs.
  • Computed tomography (CT) scans at 30 days post-TAVR were used to analyze THV geometry and its interaction with the aortic root.
  • Patients were stratified based on the degree of LVOT calcium: none/mild versus moderate/severe.

Main Results:

  • Thirty-day THV inflows showed less eccentricity in patients with none/mild LVOT calcium compared to moderate/severe LVOT calcium.
  • THV circularity was maintained at the waist, leaflet tips, and outflow across both groups.
  • Low rates of moderate or severe paravalvular leak and similar mean gradients were observed in both cohorts.

Conclusions:

  • Despite potential inflow deformities associated with moderate/severe LVOT calcium, the Evolut PRO/PRO+ THV demonstrates adaptability to elliptical aortic annuli.
  • The device maintains its circularity and functional integrity at the leaflet and outflow levels, even in the presence of significant LVOT calcification.
Abstract

Keywords:
aortic diseaseaortic valve diseasepercutaneous interventiontranscatheter valve implantation

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