Degree of valve calcification in patients undergoing transfemoral transcatheter aortic valve implantation with and without balloon aortic valvuloplasty: Findings from the multicenter EASE‐IT TF registry. Issue 3 (13th March 2019)

• Record Type: Journal Article
• Authors: Butter, Christian; Okamoto, Maki; Schymik, Gerhard; Jacobshagen, Claudius; Rothe, Jürgen; Treede, Hendrik; Kerber, Sebastian; Frank, Derk; Bramlage, Peter; Sykorova, Lenka; Thoenes, Martin; Rudolph, Tanja K.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 94:Issue 3(2019)
• Page Start: 469
• Page End: 478
• Publication Date: 2019-03-13
• Subjects: balloon aortic valvuloplasty -- calcification -- Edwards SAPIEN -- predilation -- post‐dilation -- transcatheter aortic valve implantation; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.28164
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Aims: We aimed to assess whether the level of aortic root calcification is associated with BAV performance/omission during transcatheter aortic valve implantation (TAVI), and to explore related outcomes. Methods and results: EASE‐IT TF was a prospective, observational, multicenter registry of patients undergoing TF‐TAVI with the Edwards SAPIEN 3, with or without BAV predilation. Valvular calcification was quantified from pre‐procedural multi‐slice computed tomography images and compared between BAV and no BAV patients. Data for 178 patients (55 BAV; 123 no BAV) were analyzed. There were no significant differences between groups in terms of regional/leaflet sector calcification volumes, maximum asymmetry between the different leaflet sectors, or total calcification scores. Overall, a greater‐than‐average leaflet calcification volume was independently predictive of ≥mild PVL (OR: 5.116; 95% CI: 1.042–38.35) and the need for post‐dilation (OR: 3.592; 95% CI: 1.173–12.14). The latter effect was abated in patients with BAV (OR: 1.837; 95% CI: 0.223–18.00) and intensified in those without BAV (OR: 5.575; 95% CI: 1.114–38.74). No other BAV‐dependent effects of calcification on outcomes were observed. Conclusions: In the majority of transfemoral valve implantations, calcification does not appear to be the main driving factor in the decision to perform/omit BAV. Predilation may be valuable for reducing post‐dilation requirements in patients only with a greater degree of leaflet calcification.