Bart Bosmans1,2,3,4, Valérie Collas1, Eva Verhoelst2, Bernard Paelinck1, Jos Vander Sloten3, Johan Bosmans11University of Antwerp, Department of Translational Pathophysiological Research, Cardiovascular Diseases, Faculty of Medicine and Health Sciences, Antwerp, Belgium
2Materialise N.V., Leuven, Belgium
3KULeuven, Department of Biomedical Engineering, Faculty of Engineering Science, Leuven, Belgium
4Electronic correspondence: Bart.Bosmans@kuleuven.be
Background and aim of the study: Aortic regurgitation (AR) is a frequent and life-limiting complication after transcatheter aortic valve implantation (TAVI). The study aim was to relate post-TAVI AR, using a self-expandable stent, to detailed baseline anatomical and morphological characteristics of the native aortic valve.
Methods: A total of 82 patients (40 males, 42 females; mean age 80 ± 7 years) who received a Medtronic CoreValve implant was included. Aortic root morphology, aortic annulus and implant size mismatch, implant position, extent of aortic annulus and leaflet calcification, the connected sub-annular calcification volume, and their distribution were quantified based on computed tomography scan analysis. AR following TAVI was quantified using standardized angiography and echocardiography.
Results: The mean logistic EuroSCORE of all patients was 16.9 ± 11.1%. According to angiography and
echocardiography, 41% and 39% respectively, of the patients had AR grade ≥2. The two methods correlated moderately (Spearman’s ρ = 0.51, p <0.001). The maximal diameter of the native annulus was larger in patients with significant AR after TAVI based on echocardiography (28.0 mm versus 26.8 mm, p = 0.059). Excessive calcification, especially on the left coronary cusp, was present in patients with significant AR, based on angiography (AR ≥II 71.0 mm3 versus AR <II 26.3 mm3, p = 0.001) as well as on echocardiography (AR ≥II 59.9 mm3 versus AR <II 34.0 mm3, p = 0.016).
Conclusion: Of the evaluated characteristics, a larger volume of calcification (especially on the left coronary cusp) is most related to the development of significant AR (grade II-IV) following implantation, when quantified by both angiography and echocardiography.
The Journal of Heart Valve Disease 2016;25:410-416
|Morphological Characteristics and Calcification of the Native Aortic Valve and the Relation to Significant Aortic Regurgitation after CoreValve TAVI|
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