A Simple Formula for Measuring the Aortic Valve Area in Pre-procedural Echocardiography for Transcatheter Aortic Valve Implantation: An Innovation

Objective In this report, we assess the outcome of transcatheter aortic valve implantation (TAVI) in nonagenarians at our institution during a 6-year period. Methods Between April 2008 and July 2014, 40 patients with a mean ± SD age of 91.8 ± 2.3 years (range, 90–98 years) underwent TAVI. Thirty-three patients (82.5%) received transapical TAVI, and seven patients (17.5%) received transfemoral TAVI. Baseline characteristics were as follows: mean ± SD EuroSCORE II, 23.9 ± 14.21; mean ± SD Society of Thoracic Surgeons mortality score, 24.2 ± 11.4; mean ± SD SYNTAX score, 7.6 ± 9.3; mean ± SD NYHA class, 3.5 ± 0.5; mean ± SD transvalvular gradient, 46.8 ± 17.8 mm Hg; mean ± SD aortic valve area, 0.7 ± 0.2 cm2. Results Intraoperative mortality was 2.5% and 30-day all-cause mortality was 10%. The actuarial survival rates at 1 and 5 years were 58.6% and 30.4%, respectively. Seven patients (17.5%) underwent simultaneous elective TAVI and percutaneous coronary intervention. Three patients (7.5%) were operated on with the use of cardiopulmonary bypass. No conversion to open surgery occurred. In transesophageal echocardiography assessment, no moderate or severe prosthetic aortic valve regurgitation was observed. Four patients (10%) had postoperative acute renal failure stage 3 and needed new dialysis (P = 0.125). Three patients (7.5%) had a disabling stroke. Periprocedural myocardial infarction occurred in one patient (2.5%). Seven patients (17.5%) needed postoperative pacemaker implantation. Male sex and renal insufficiency were found to be predictors of mortality in univariable analysis. Conclusions Transcatheter aortic valve implantation can be performed in nonagenarians despite very high preoperative risk scores and substantial multimorbidity, with acceptable outcomes.

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The effect of underweight on mid-term outcome following transcatheter aortic valve implantation: an insight from multicenter registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.1942 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Tezuka ◽

R Higuchi ◽

K Hagiya ◽

M Saji ◽

I Takamisawa ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Obesity Paradox ◽

Prognostic Impact ◽

Aortic Valve Area ◽

Term Outcome ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Underweight Patients ◽

Valve Implantation

Abstract Background Obesity has the adverse prognostic impact in the general population, whereas paradoxical effect of obesity has been reported in patients with heart failure. Several studies have suggested the same obesity paradox in patients undergoing transcatheter aortic valve implantation (TAVI), however, they included limited number of underweight patients. Purpose The aim of this study was to clarify the effect of underweight on outcome following TAVI. Methods We retrospectively analyzed consecutive 1,027 patients undergoing TAVI between April 2010 and June 2019. The patients were categorized according to body mass index (BMI) as follows: underweight (<18.5 kg/m2, n=150), normal weight (18.5 to 25 kg/m2, n=657), and overweight (>25 kg/m2, n=220). BMI was defined as body weight (kg) divided by the square of body height (m) measured at the hospital admission. We compared the short- and mid-term outcome after TAVI among three groups, and all clinical events were accordance with Valve Academic Research Consortium-2 criteria. Results Underweight patients were more often female, and had a higher prevalence of hypertension, dyslipidemia, peripheral artery disease, anemia, and hypoalbuminemia. They also presented lower ejection fraction, smaller aortic valve area, and higher surgical risk score. In procedural findings, device unsuccess and major vascular complication more occurred in underweight patients, but 30-day mortality was equivalent among three groups. The mid-term survival of the underweight was inferior to the other two groups (figure).In the multivariate analysis, female (hazard ratio [HR] 0.52, 95% confidence interval [CI] 0.37–0.73, P=0.0002), atrial fibrillation (HR 2.22, 95% CI 1.56–3.17, P<0.0001), albumin value (HR 0.37 per 1-g/dl increase, 95% CI 0.25–0.55, P<0.0001), Society of Thoracic Surgeons score (HR 1.06 per 1% increase, 95% CI 1.02–1.06, P=0.0039), 30-day combined endpoint (HR 2.12, 95% CI 1.33–3.38, P=0.0017), and underweight (HR 1.59, 95% CI 1.04–2.37, P=0.026) were associated with the survival after TAVI. Conclusion The underweight had a worse mid-term prognosis, representing the obesity paradox in the TAVI population. Kaplan-Meier curves Funding Acknowledgement Type of funding source: None

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The prediction of atrial fibrillation development in patients treated with transcatheter aortic valve implantation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.149 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

UN Karakulak ◽

ML Sahiner ◽

YZ Sener ◽

EB Kaya ◽

K Aytemir

Keyword(s):

Atrial Fibrillation ◽

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

P Wave ◽

Aortic Valve Area ◽

Total N ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation ◽

New Onset

Abstract Funding Acknowledgements Type of funding sources: None. Backround Atrial fibrillation (AF) is associated with poor outcomes after transcatheter aortic valve implantation (TAVI). Purpose This study aimed to investigate whether prolonged total atrial conduction time (PA-TDI) predicts the development of AF in TAVI-treated patients. Methods A total of 307 TAVI-treated patients were enrolled. PA-TDI was defined as the duration from P wave onset on electrocardiography to peak A′ wave on tissue Doppler imaging echocardiography. Results The study was conducted with 263 patients because 44 patients had pre-existing AF. Of 263, 47 (17.8%) had new-onset AF after TAVI procedure. Age, mortality and the frequency of PM implantation were higher in the AF group. LVEDD, LVEF, aortic gradients, and AVA were similar between AF and sinus rhythm groups; however, LVESD, LA diameter, and PA-TDI duration were increased in the AF group. In Kaplan–Meier analysis (Panel A), there was an increase in risk of AF with each incremental percentile of the PA-TDI duration. In multivariate analysis, age (p = 0.005) and PA-TDI duration (p = 0.002) were found to be independent risk factors for the development of AF after TAVI. AUC was 0.630 (p = 0.005), and the sensitivity and specificity were 70% and 51% respectively at a cut-off point of 123.5 ms for PA-TDI duration (Panel B). Conclusion In patients treated with TAVI, post-procedural new-onset AF may lead to significant risk for morbidity and mortality. PA-TDI duration can be used for the detection of the patients with high risk of AF development. Total (n = 263) Sinus (n = 216) AF (n = 47) p value Age (years) 78.0 ± 10.8 77.5 ± 11.2 80.6 ± 8.4 0.032 Gender (F/M) 144/119 118/98 26/21 0.932 Follow-up time (months) 2 [1-77] 2 [1-77] 1 [1-51] 0.095 Death 82 (31.2%) 59 (27.3%) 23 (48.9%) 0.004 Pacemaker implantation 44 (16.7%) 32 (14.8%) 12 (25.5%) 0.075 LV end-diastolic diameter (mm) 48.2 ± 3.5 47.9 ± 5.3 49.3 ± 5.4 0.202 LV end-systolic diameter (mm) 32.2 ± 5.5 31.7 ± 5.0 35.0 ± 6.8 0.030 LV ejection fraction (%) 55.2 ± 10.9 55.4 ± 10.9 54.2 ± 11.1 0.515 LA diameter (mm) 42.9 ± 6.5 41.9 ± 6.6 44.7 ± 6.1 0.049 Peak aortic gradient (mmHg) 78.6 ± 20.5 79.2 ± 20.5 77.2 ± 20.7 0.660 Mean aortic gradient (mmHg) 46.8 ± 13.5 46.6 ± 13.2 47.2 ± 14.3 0.838 Aortic valve area (cm2) 0.73 ± 0.15 0.73 ± 0.15 0.74 ± 0.14 0.734 PA-TDI duration (ms) 127.0 ± 26.7 125.4 ± 26.2 137.0 ± 27.2 0.009 Abstract Figure.

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P1811 Prognostic impact of different subtypes of severe aortic stenosis undergoing transcatheter aortic valve implantation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1162 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

M Pal ◽

G Dekany ◽

A Mandzak ◽

Z S Piroth ◽

G Fontos ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Transcatheter Aortic Valve Implantation ◽

Left Ventricular ◽

Prognostic Impact ◽

Aortic Valve Area ◽

Transcatheter Aortic Valve ◽

All Cause Mortality ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Background Outcomes for different subtypes of aortic stenosis defined by transvalvular flow and gradient after transcatheter aortic valve implantation (TAVI) are still subjects of debate. Purpose The aim of the study was to evaluate the prognostic impact of the initial transvalvular flow rate and aortic mean gradient on survival and to assess the changes of left ventricular function after TAVI. Patients and Methods From 2008. to 2017.06.30. TAVI was performed in 300 cases in our Institute (127 men, 173 women, mean age 80,0 ± 5,8 years) with severe (aortic valve area <1,0 cm²) symptomatic aortic stenosis (AS) and contraindication or high risk for surgery. Median time for follow-up was 28 (0-115) months, Echocardiography was performed before and 12 months after TAVI. Patients were divided into four groups according to flow (F) , aortic mean gradient (Gr) and ejection fraction (EF): HG Gr ≥ 40 mmHg (n = 237) LF-LG : F ≤ 35 ml/m2, Gr < 40 mmHg and EF < 50% (n = 41) PLF-LG: F ≤ 35 ml/m2, Gr < 40 mmHg and EF ≥50% (n = 9) NF-LG: F > 35 ml/m2 and Gr < 40 mmHg (n = 13) Our primary objective was the analysis of 30-day, 1-year and 3-year all-cause mortality of these groups, secondary goal was to observe the changes in EF after 12 months in the survivors. Results In the whole patient group 30-day all-cause mortality was 4,3%, 1-year 17,0% and 3-year 62,0%. The NFLG group had the most favourable outcomes (mortality: 30d 0, 1-year: 7,7%, 3-year: 46,2%). Mortality was low in the HG group in the 1st year (30-day: 3,8%, 1-y: 14,3%), but it increased to 62,8% at 3-year. Mortality rates were intermediate in the PLF-LG group (30-day 0, 1-year 22,2%, 3-year 55,6%) and were the highest in LF-LG (30-day 12,2%, p = 0,03 vs HG, 1-year 34,2% p = 0,005 vs. HG, 3-year 75,6%). Among clinical and echocardiographic variables only moderate or severe paravalvular aortic regurgitation (p = 0,03) and severe renal dysfunction (GFR <30 ml/min, p = 0,02) were independent predictors of all-cause 1-year mortality. In patients with severe (EF < 30%) , moderate (EF 30-40%) or mild ( EF 41-50%) systolic dysfunction the EF improved after TAVI (23,5 ± 3,5% vs. 30,3 ± 7,9% p < 0,001, 33,6 ±3,6% vs. 43,0 ± 10,5% p = 0,003, 45,5 ± 3,1% vs. 54,3 ± 8,7% p < 0,001) regardless of the initial flow and gradient subtype of AS. Conclusions Low flow-low gradient aortic stenosis is associated with worse short or long term prognosis after TAVI, therefore this subtype of AS needs detailed risk stratification before-, and careful management after TAVI. Improvement of initial left ventricular dysfuncion can be expected after TAVI.

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Indications and outcomes of TAVI (transcatheter aortic valve implantation) in Iceland

Læknablaðið ◽

10.17992/lbl.2021.03.625 ◽

2021 ◽

Vol 107 (03) ◽

pp. 123-129

Author(s):

Katrín Júníana Lárusdóttir ◽

◽

Hjalti Guðmundsson ◽

Árni Johnsen ◽

Martin Ingi Sigurðsson ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Reference Population ◽

Aortic Valve Area ◽

Term Survival ◽

Long Term Survival ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

INTRODUCTION: Surgical aortic valve replacement (SAVR) has been the standard of treatment for aortic stenosis but transcatheter aortic valve implantation (TAVI) is increasingly used as treatment in Iceland and elsewhere. Our objective was to assess the outcome of TAVI in Iceland, focusing on indications, complications and survival. MATERIAL AND METHODS: This retrospective study included all TAVI-procedures performed in Iceland between January 2012 and July 2020. Patient characteristics, outcome and complications were registered, and overall survival compared to an age and sex matched Icelandic reference-population. The mean follow-up was 2.4 years. RESULTS: Altogether 189 TAVI procedures (mean age 83±6 years, 41.8% females), were performed, all with a self-expandable valve. Most patients (81.5%) had symptoms of severe heart failure (NYHA-class III-IV) and median EuroSCORE-II was 4.9 (range: 0.9-32). Echocardiography pre-TAVI showed a mean aortic-valve area of 0.67 cm2 and max aortic-valve gradient of 78 mmHg. One out of four patients (26.5%) needed permanent pacemaker implantation following TAVI. Other complications were mostly vascular-related (13.8%) but cardiac tamponade stroke was detected in 3.2 and 2.6% of cases, respectively and severe paravalvular aortic valve regurgitation in 0.5% cases. Thirty-day mortality was 1.6% (n=3) with one-year survival of 93.5% (95% CI: 89.8-97.3), but long-term survival of TAVI-patients was similar to the matched reference population (p=0.23). CONCLUSIONS: The outcome of TAVI-procedures in Iceland is good, especially regarding 30-day mortality and long-term survival that was comparable to a reference population, but incidence of major complications was also low.

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Long-term outcomes after transcatheter aortic valve implantation. An analysis of 5-year survival and beyond

European Heart Journal ◽

10.1093/ehjci/ehaa946.3222 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Stathogiannis ◽

M Drakopoulou ◽

G Oikonomou ◽

S Soulaidopoulos ◽

P Toskas ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Nyha Class ◽

Aortic Valve Area ◽

Class Iii ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) has seen an unprecedented rise in the past decade and has become the gold-standard therapy for inoperable, high- and intermediate-risk patients with aortic valve stenosis. Purpose To investigate the long-term clinical outcomes (5-year survival and beyond) of patients undergoing TAVI. Methods Consecutive patients who underwent TAVI with a self-expanding valve between 2012 - 2015 were included in the study. Patients with bicuspid valves and valve-in-valve procedures were excluded. Clinical follow-up was performed at specified time intervals (30-day post TAVI and yearly thereafter). The primary endpoint of this study was to evaluate survival rates in the long-term (≥5 years). Secondary endpoints were echocardiographic findings and clinical status at 5 years. All endpoints were considered as per the VARC-2 criteria and the latest consensus documents. Results In total, 267 patients were included in the study. Complete follow-up was complete in 189 (70%) patients. The mean age at implantation was 80.71±6.81 years, 129 (48%) were female, mean logistic EuroSCORE was 24.28±8.64% and 73% of patients were at NYHA Class III. The median follow-up was 4.0±1.5 years. Before the procedure, ejection fraction (EF) was 49.92±9.37%, mean gradient was 48.83±14.68mmHg, pulmonary artery systolic pressure (PASP) was 44.31±12.72mmHg and aortic valve area was 0.98±5.02cm2. All patients received the self-expanding valve (mean valve size was 27.60±2.12mm), with the majority of them undergoing transfemoral TAVI (71%). Predilation was performed in 77% of the population and post TAVI dilation was performed in 20%. Compared to pre TAVI values, EF was higher at 50.66±9.37% (p=0.041), mean gradient was lower at 9.41±4.65mmHg (p<0.001), PASP was lower at 41.55±9.93mmHg (p=0.005) and aortic valve area was higher at 1.69±0.81cm2 (p<0.001) post TAVI. At the end of the fifth year, 160 (60%) patients were alive. Mean survival post TAVI was 32 months (median: 32.2 months, range: 0–91.2 months) and the majority of deaths were non-cardiac in nature (78%). Also, 43% patients of patients were at NYHA Class I, 50% were at NYHA Class II and 7% were at NYHA Class III. At multivariate analysis, sole independent predictor of death at 5 years was baseline PASP levels (OR 1.027, 95% CI: 1–1.054, p=0.049). Conclusion Transcatheter aortic valve implantation offers a viable solution for aortic stenosis patients and long-term results beyond 5 years are reassuring. Further studies are necessary in order to shed a light for very long-term outcomes. Funding Acknowledgement Type of funding source: None

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Intravascular haemolysis after transcatheter aortic valve implantation with self-expandable prosthesis: incidence, severity, and impact on long-term mortality

European Heart Journal Supplements ◽

10.1093/eurheartj/suaa098 ◽

2020 ◽

Vol 22 (Supplement_F) ◽

pp. F44-F50

Author(s):

Andrea Širáková ◽

Petr Toušek ◽

František Bednář ◽

Hana Línková ◽

Marek Laboš ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Regurgitation ◽

Aortic Valve Area ◽

Intravascular Haemolysis ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation ◽

Valve Area

Abstract We aimed to determine the incidence, severity, and long-term impact of intravascular haemolysis after self-expanding transcatheter aortic valve implantation (TAVI). We believe this should be evaluated before extending the indications of TAVI to younger low-risk patients. Prospective, academic, single centre study of 94 consecutive patients treated with supra-annular self-expandable TAVI prosthesis between April 2009 and January 2014. Haemolysis at 1-year post-TAVI was defined per the published criteria based on levels of haemoglobin, reticulocyte and schistocyte count, lactate dehydrogenase (LDH), and haptoglobin. All patients had long-term clinical follow-up (6 years). The incidence of haemolysis at 1-year follow-up varied between 9% and 28%, based on different haemolysis definitions. Haemolysis was mild in all cases, no patient had markedly increased LDH levels. The presence of moderate/severe paravalvular aortic regurgitation was associated with haemolysis (7.7% vs. 23.1%, P = 0.044) and aortic valve area post-TAVI did not differ between groups with or without haemolysis (1.01 vs. 0.92 cm2/m2, P = 0.23) (definition including schistocyte count). The presence of haemolysis did not have any impact on patient prognosis after 6 years with log-rank test P = 0.80. Intravascular haemolysis after TAVI with self-expandable prosthesis is present in 9–28% of patients depending on the definition of haemolysis. The presence of haemolysis is associated with moderate/severe paravalvular aortic regurgitation but not with post-TAVI aortic valve area. Haemolysis is mild with no impact on prognosis.

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One-year echocardiographic outcomes of transcatheter aortic valve implantation with or without predilatation of the aortic valve: insights from the multicenter, randomized DIRECT trial

European Heart Journal ◽

10.1093/ehjci/ehaa946.0065 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Karmpalioti ◽

G Benetos ◽

M Drakopoulou ◽

M Xanthopoulou ◽

K Stathogiannis ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Funding Source ◽

Aortic Valve Area ◽

Transcatheter Aortic Valve ◽

Significant Difference ◽

Aortic Valve Implantation ◽

One Year ◽

Valve Implantation

Abstract Introduction Transcatheter aortic valve implantation (TAVI) has become the standard of care for high-risk and inoperable surgical patients and a valid alternative in intermediate-risk patients with severe aortic stenosis.The DIRECT trial (Predilatation in Transcatheter Aortic Valve Implantation Trial) was a multicenter, randomized, clinical trial designed to evaluate the safety and efficacy of TAVI with or without balloon aortic valvuloplasty (BAV) in patients with symptomatic, severe aortic valve stenosis. Purpose To compare the one year echocardiographic findings among patients, who underwent TAVI using a self-expanding valve with or without BAV. Methods A total of 171 patients with severe aortic stenosis were randomly assigned at 4 tertiary centers to undergo TAVI with the use of self-expanding prostheses with (pre-BAV) or without pre-dilatation (no-BAV). Follow up transthoracic echocardiography was performed 1 year after TAVI. Results Of 171 patients, 86 patients were randomized to pre-BAV group and 85 to no-BAV group. One year echocardiographic follow up was available in 146 patients. In one year follow up there was no significant difference between pre-BAV and no-BAV group in aortic valve area (1.84±0.39cm2 vs. 1.85±0.44cm2, p=0.79), peak aortic valve gradient (15.95±9.97 mmHg vs. 14.51±6.60 mmHg, p=0.35), mean aortic valve gradient (8.37±5.01 mmHg vs. 7.99±4.04 mmHg, p=0.64), aortic valve peak velocity (1.90±0.51 m/s vs. 1.80±0.42m/s, p=0.24), ejection fraction (54.19±8.36% vs. 53.19±9.58%, p=0.52) and pulmonary artery systolic pressure (41.86±14.34 mmHg vs. 40.71±12.40 mmHg, p=0.64). The incidence of moderate or severe paravalvular regurgitation (PVL) in 1 year follow up was 6.2% without significant difference between the 2 study groups (5.7% in the no-BAV group vs. 6.6% in the pre-BAV group, p=0.83). Conclusions Direct transcatheter aortic valve implantation has no impact on one-year prosthesis function and PVL in patients undergoing TAVI with self-expanding valve Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Medtronic

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P5583Micro-movement during transcatheter aortic valve implantation with a contemporary self-expandable prosthesis

European Heart Journal ◽

10.1093/eurheartj/ehz746.0527 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Hellhammer ◽

K Piayda ◽

V Veulemans ◽

S Afzal ◽

I Hennig ◽

...

Keyword(s):

Risk Factor ◽

Aortic Valve ◽

Aortic Regurgitation ◽

Aortic Valve Area ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Coronary Cusp ◽

Valve Implantation ◽

Valve Area

Abstract Background Precise positioning of the prosthesis is a crucial step during transcatheter aortic valve implantation. In some cases, contemporary self-expandable prostheses show micro-movement (MM) during the final phase of release. Purpose We aimed to establish a definition for MM, evaluated the incidence of MM using the CoreValve Evolut RTM, investigated potential risk factors for MM and the associated clinical outcomes. Methods MM was defined as movement of the prosthesis of at least 1.5 mm from its position directly before release compared to its final position. Patients were grouped according to the occurrence (+MM) or absence (-MM) of MM. Baseline characteristics, imaging data and outcome parameters in accordance with the updated valve academic research consortium (VARC-2) criteria were retrospectively analyzed. Results We identified 258 eligible patients. MM occurred in 31.8% (n=82) of cases with a mean magnitude of 2.8±2.2 mm in relation to the left coronary cusp and 3.0±2.1 mm to the non-coronary cusp. Clinical and hemodynamic outcomes were similar in both groups. The mean pressure gradient was effectively reduced after TAVI (-MM vs. +MM: 7±3.4 mmHg vs. 8±3.9 mmHg, p=0.326) with consistency over a follow-up period of at least three months (-MM vs. +MM: 6.7±3.7 mmHg vs. 7.9±8.4 mmHg, p=0.168). At three months follow-up most of the patients presented with no aortic regurgitation (-MM vs. +MM: 64% vs. 67.9%, p=0.569). Mild aortic regurgitation was observed in 34.2% of the -MM group and in 29.5% of the +MD group (p=0.414). Moderate aortic regurgitation occurred in 1.9% of all patients with no differences between groups (-MM vs. +MM: 1.9% vs. 2.6%, p=0.662). Patients with MM presented with a more symmetric calcification pattern (-MM vs. +MM: 27.3% vs. 40.2%; p=0.037) and a larger aortic valve area (-MM vs. +MM: 0.6 cm2 ± 0.3 vs. 0.7 cm2 ± 0.2; p=0.014), which was found to be a potential risk factor for the occurrence of MM in a multivariate regression analysis (OR 3.5; 95% CI: 1.1–10.9; p=0.032) Conclusion MM occurred in nearly one third of patients and did not affect clinical and hemodynamic outcome. A larger aortic valve area was the only independent risk factor for the occurrence of MM.

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