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Published on: February 4, 2021
Transcatheter Aortic Valve Explants: Calcification Patterns and Leaflet Thickening to Inform Repeat Interventions.
David Meier1, Joshua Yoon2, Cole Glenna3
1Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Cardiovascular Translational Lab, Centre for Cardiovascular Innovation, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: http://twitter.com/david_meier_.
Degeneration of transcatheter aortic valves (TAVs) is common. Explanted TAVs show calcification and thickening, with patterns varying by TAV type, impacting future interventions.
Area of Science:
- Cardiovascular Research
- Biomaterials Science
- Medical Imaging
Background:
- Bioprosthetic heart valve degeneration is inevitable.
- Transcatheter aortic valve replacement (TAVR) calcification and leaflet thickening affect repeat interventions.
- Understanding explanted TAV characteristics is crucial for procedural planning.
Purpose of the Study:
- To investigate the frequency and pattern of leaflet calcification and thickening in explanted transcatheter aortic valves (TAVs).
- To inform strategies for repeat TAVR procedures and leaflet modification techniques.
Main Methods:
- Analysis of 20 explanted TAVs (CoreValve/Evolut, SAPIEN 3, Lotus).
- Micro-computed tomography (micro-CT) and histology to assess calcium volume, distribution, and leaflet thickness.
- Correlation of leaflet thickness with implant duration.
Main Results:
- 55% of explanted TAVs showed leaflet calcification.
- Calcified TAVs exhibited significantly increased leaflet thickness compared to non-calcified ones.
- Calcium distribution was heterogeneous within leaflets and varied between TAV models.
- Leaflet thickness positively correlated with implant duration.
Conclusions:
- Calcified TAVs are associated with thicker leaflets.
- Calcium distribution patterns differ among TAV types.
- Findings have implications for planning redo-TAVR and leaflet modification procedures.
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