A new calcium score to predict paravalvular leak in transcatheter aortic valve implantation

Abstract OBJECTIVES The present study sought to develop a reliable calcium score (Ca-score) to predict paravalvular leak (PVL) in patients undergoing transcatheter aortic valve (AV) implantation. METHODS A total of 965 patients were prospectively included from 2012 to 2019. Preprocedural contrast-media-enhanced computed tomography scans were analysed regarding the amount of AV cusp calcification and the presence of upper and lower left ventricular outflow tract calcification. The calcium volume threshold of each AV cusp [non-coronary cusp (NCC); left coronary cusp (LCC); right coronary cusp (RCC)] with optimal PVL prediction was defined using the Youden index value derived from receiver operating characteristic analysis. The final score was developed based on the multivariable regression analysis, while individual variables were weighted based on their corresponding odds ratio. RESULTS The AV calcium volume threshold with optimal PVL prediction was 733.6, 296.0 and 131.2 mm3 for the NCC, RCC and LCC respectively. Overall, calcification of the upper left ventricular outflow tract was present in 233 (23%), 111 (12%) and 304 (32%) of patients below the NCC, RCC and LCC respectively, while 260 (27%), 44 (5%) and 217 (23%) patients suffered from calcification under the NCC, RCC and LCC, respectively. A total Ca-score of ≥4 was present in 356 (37%) of patients and was independently associated with ≥ mild PVL [odds ratio 3.662; 95% confidence interval (2.740–4.911); P < 0.001]. The area under the curve of the Ca-score was 0.713 [95% confidence interval (0.678–0.748); P < 0.001]. CONCLUSION The provided Ca-score independently correlates with the development of PVL and improves risk stratification in patients undergoing transcatheter AV implantation.

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LEFT VENTRICULAR OUTFLOW TRACT CALCIUM SCORE PREDICTS THE DEVELOPMENT OF PARAVALVULAR LEAK AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR)

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)02493-1 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1134

Author(s):

Daneyal Syed ◽

Khaled Dajani ◽

Menhel Kinno ◽

Mark Rabbat ◽

Ferdinand Leya ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Left Ventricular Outflow Tract ◽

Calcium Score ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Paravalvular Leak ◽

Transcatheter Aortic Valve ◽

Left Ventricular Outflow

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IMPACT OF LEFT VENTRICULAR OUTFLOW TRACT (LVOT) MORPHOLOGY AND LVOT-ANNULAR MISMATCH ON PARAVALVULAR LEAK AND NEW CONDUCTION ABNORMALITIES AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT: CONCEPT OF THE “NON-TUBULAR INDEX” AND LVOT SEAL ZONE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(18)31673-5 ◽

2018 ◽

Vol 71 (11) ◽

pp. A1132

Author(s):

Gilbert Hin-Lung Tang ◽

Syed Zaid ◽

Samuel Schnittman ◽

Hasan Ahmad ◽

Ryan Kaple ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Left Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Paravalvular Leak ◽

Transcatheter Aortic Valve ◽

Left Ventricular Outflow

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Incidence, Predictors, and Outcome of Paravalvular Leak after Transcatheter Aortic Valve Implantation

Journal of Interventional Cardiology ◽

10.1155/2020/8249497 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Abdullah Hagar ◽

Yijian Li ◽

Xin Wei ◽

Yong Peng ◽

Yuanning Xu ◽

...

Keyword(s):

Aortic Valve ◽

Left Ventricular Outflow Tract ◽

Independent Predictor ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Paravalvular Leak ◽

Transcatheter Aortic Valve ◽

Left Ventricular Outflow ◽

Valve Implantation

Background. Paravalvular leak (PVL) is common after transcatheter aortic valve implantation (TAVI) and has been linked with worse survival. This study aimed to investigate the determinants and outcome of PVL after TAVI and determine the role of aortic valve calcification (AVC) distribution in predicting PVL. Methods and Results. This was a retrospective cohort study of 270 consecutive patients who underwent TAVI. Determinants and outcomes of ≥mild PVL were assessed. Matching rates of PVL jet with AVC distribution were calculated. AVC volume, larger annulus dimensions, and transvalvular peak velocity were risk factors for ≥mild PVL after TAVI. AVC volume was an independent predictor of ≥mild PVL. On the other hand, annulus ellipticity, left ventricular outflow tract nontubularity, and diameter-derived prosthesis mismatch were not found to predict PVL after TAVI. PVL jet matched, in varying proportions, with calcification at all aortic root regions, and the highest matching rate was with calcifications at body of leaflets. Moreover, matching rates were less with commissure compared to cusp calcifications. Mild or greater PVL was not associated with all-cause and cardiovascular mortality up to 1-year follow-up. Conclusion. ≥mild PVL after TAVI is common and can be predicted by aortic root calcification volume, larger annulus dimensions, and pre-TAVI transvalvular peak velocity, with calcification volume being an independent predictor for PVL. However, annulus ellipticity, left ventricular outflow tract nontubularity, and diameter-derived prosthesis mismatch had no role in predicting PVL. Importantly, body of leaflet calcifications (versus annulus and tip of leaflet) and cusp calcifications (versus commissure calcification) are more important in predicting PVL. No association between ≥mild PVL and increased risk of all-cause and cardiovascular mortality at 1-year follow-up.

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