Maxim Avanesov MD, Presenter: Nothing to Disclose

Moritz Seiffert, Abstract Co-Author: Nothing to Disclose

Clemens Lunau, Abstract Co-Author: Nothing to Disclose

Aortic valve calcium is a predictor for aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) and is associated with adverse outcome. 2nd generation devices promise to reduce residual AR, so we evaluated aortic valve calcium and post-procedual AR in 1st and 2nd generation transcatheter aortic valves as well as among different 2nd generation devices.

TAVI was performed using 1st and 2nd generation devices in 156 patients with severe aortic stenosis and high surgical risk. Devices implanted were Edwards SapienXT(n=52), Medtronic CoreValve (n=33), Symetis Acurate(n=25), JenaValve(n=20) and Medtronic Engager(n=26) valves. All patients received preoperative contrast-enhanced CT scans with prospective ECG gating. 3D-reconstructions were performed by 3Mensio software (3MensioMedical Imaging, Bilthoven).Calcium load was quantified within the device-landing area, sub-divided into zone 1 (left coronary artery ostium to aortic annulus and zone 2 (aortic annulus to 10mm below). A cutoff of 500HU was used to distinguish aortic calcium from intraluminal contrast agent. In another group of 138 patients receiving 2nd generation devices only, aortic calcium was measured separately for each leaflet and compared among all implanted devices with regard to residual AR.

The highest aortic valve calcium(zone1+2) among 1st generation devices was seen in patients with CoreValve(3141±2232mm3) whereas the Engager valve reveiled the highest calcium loads among 2nd generation valves(2396±1027mm3). Mean post-procedural AR was none/trace in 66% and greater trace in 34%, CoreValve showed the highest rate of AR greater trace with 59%. Only Engager valve had the highest calcium score (896±445mm³), while AR rates weren’t significantly different among other valve types. Re-Dilatation rates increased with higher calcium load (p=0.01) while the number of pacemaker implantation didn’t alter significantly

TAVI using 1st and 2nd generation devices revealed good hemodynamic results, irrespective of annular calcification. CoreValve was associated with highest rate of AR greater trace, while Engager valve, mostly used in patients with higher calcium load, showed no difference in post-procedural AR.

1st and 2nd generation TAVI devices are safe irrespective of aortic valve calcium. Only Engager valve reveiled low residual AR despite significantly higher aortic valve calcium.             

Avanesov, M, Seiffert, M, Lunau, C, Size of Aortic Valve Calcium with Regard to Post-Procedural Aortic Regurgitation after Transcatheter Aortic Valve Implantation with First- and Second-generation Transcatheter Heart Valves.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014957.html