Jonathon Avrom Leipsic MD, Presenter: Speakers Bureau, General Electric Company Speakers Bureau, Edwards Lifesciences Corporation Consultant, Heartflow, Inc Consultant, Circle Cardiovascular Imaging Inc

Bruce Precious MD, Abstract Co-Author: Nothing to Disclose

Sasi Rekha Ganga Raju, Abstract Co-Author: Nothing to Disclose

Nicolaj Hansson, Abstract Co-Author: Nothing to Disclose

Philipp Blanke MD, Abstract Co-Author: Nothing to Disclose

Bjarne Norgaard, Abstract Co-Author: Consultant, Edwards Lifesciences Corporation

  We sought to further delineate the impact of calcium volume and distribution on aortic root injury using a new method of detailed quantitative calcium analysis                                                         

33 patients from 16 centers experiencing aortic root injury were compared to consecutive control of 156  patients without root injury. Quantitative calcium analysis using patient-specific calcium detection thresholds and detailed 3-dimensional regional analysis on contrast-enhanced pre-TAVR MDCT scans was performed. Calcium quantified volumetrically in relation to the three aortic cusps in three regions: 1) aortic valve/ sinus of Valsalva calcium (from the aortic annulus to the left coronary ostia), 2) overall left ventricular outflow tract (LVOT) calcium (from the aortic annulus and 10 mm into the left ventricle) and 3) high LVOT/subannular calcium (from the aortic annulus and 2 mm into the left ventricle).                 

Median (interquartile range) overall LVOT and high LVOT/subannular calcium volumes were higher in the rupture group 74 (5-326) mm3 vs. 4 (0-63) mm3 (p<0.0001), and 29 (3-66) mm3 vs. 0 (0-9) mm3 (p<0.0001). No difference between groups in aortic valve/sinus of Valsalva calcium volume, 848 (390-1138) mm3 vs. 546 (296-976) mm3 (p=0.09). High LVOT/subannular calcium volume was more predictive of aortic root injury than overall LVOT calcium volume, (AUC) of 0.78 (95% confidence interval [CI]: 0.70-0.87) vs. 0.71 (95% CI: 0.61-0.81) (p=0.002). Aortic valve/sinus of Valsalva calcium volume did not predict aortic root injury (AUC: 0.57; 95% CI: 0.48-0.70). High LVOT/subannular calcium underneath the non-coronary cusp was significantly more predictive of aortic root injury (AUC: 0.81; 95% CI: 0.72-0.90) compared to calcium underneath the right cusp (AUC: 0.67; 95% CI: 0.58-0.77; p=0.02), or the left cusp (AUC: 0.65; 95% CI: 0.55-0.75; p=0.02). Prosthesis oversizing >20% (likelihood ratio test p=0.048) and redilatation (likelihood ratio test p=0.009) significantly improved prediction of root injury by high LVOT/subannular calcium.

 High LVOT/subannular calcium volume, particularly located below the non-coronary cusp, is more predictive of aortic root rupture than overall LVOT calcium. Prosthesis oversizing >20% and redilatation augments the impact of high LVOT/subannular calcium on the risk of root injury.

 These findings may help identify patients at risk of aortic root injury during balloon-expandable TAVR.

Leipsic, J, Precious, B, Ganga Raju, S, Hansson, N, Blanke, P, Norgaard, B, The Impact of Calcium Volume and Distribution in Aortic Root Injury Related to Balloon-Expandable Transcatheter Aortic Valve Replacement  .  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007198.html