Nicolaj C Hansson1, Bjarne L Nørgaard2, Marco Barbanti3, Niels Erik Nielsen4, Tae-Hyun Yang5, Corrado Tamburino6, Danny Dvir7, Hasan Jilaihawi8, Phillip Blanke9, Raj R Makkar8, Azeem Latib10, Antonio Colombo10, Giuseppe Tarantini11, Rekha Raju7, David Wood7, Henning R Andersen2, Henrique B Ribeiro12, Samir Kapadia13, James Min8, Gudrun Feuchtner14, Ronen Gurvitch15, Faisal Alqoofi16, Marc Pelletier17, Gian Paolo Ussia18, Massimo Napodano10, Fabio Sandoli de Brito19, Susheel Kodali20, Gregor Pache9, Sergio J Canovas21, Adam Berger7, Darra Murphy7, Lars G Svensson13, Josep Rodés-Cabau12, Martin B Leon20, John G Webb7, Jonathon Leipsic7. 1. Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Aarhus, Denmark. Electronic address: nh@dadlnet.dk. 2. Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Aarhus, Denmark. 3. St Paul's Hospital, Vancouver, Canada; Ferrarotto Hospital, University of Catania, Catania, Italy. 4. Linköping University Hospital, Linköping, Sweden. 5. St Paul's Hospital, Vancouver, Canada; Busan Paik Hospital, Inje University, Gimhae, South Korea. 6. Ferrarotto Hospital, University of Catania, Catania, Italy. 7. St Paul's Hospital, Vancouver, Canada. 8. Cedars-Sinai Heart Institute, Los Angeles, CA, USA. 9. University Hospital Freiburg, Freiburg, Germany. 10. EMO-GVM Centro Cuore Columbus, Milan, Italy; San Raffaele Scientific Institute, Milan, Italy. 11. University of Padua, Padua, Italy. 12. Quebec Heart and Lung Institute, Laval University, Quebec City, Canada. 13. Cleveland Clinic, Cleveland, OH, USA. 14. Innsbruck Medical University, Innsbruck, Austria. 15. Royal Melbourne Hospital, Melbourne, Australia. 16. University of Calgary, Calgary, Canada. 17. New Brunswick Heart Centre, Saint John, Canada. 18. Department of Cardiovascular Disease, Tor Vergata University of Rome, Rome, Italy. 19. Hospital Israelita Albert Einstein, Sao Paulo, Brazil. 20. Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY, USA. 21. Arrixaca University Hospital, Murcia, Spain.
Abstract
BACKGROUND: A detailed assessment of calcium within the aortic root may provide important additional information regarding the risk of aortic root injury during transcatheter heart valve replacement (TAVR). OBJECTIVE: We sought to delineate the effect of calcium volume and distribution on aortic root injury during TAVR. METHODS: Thirty-three patients experiencing aortic root injury during TAVR with a balloon-expandable valve were compared with a control group of 153 consecutive TAVR patients without aortic root injury (as assessed by post-TAVR multidetector CT). Using commercial software to analyze contrast-enhanced pre-TAVR CT scans, calcium volume was determined in 3 regions: (1) the overall left ventricular outflow tract (LVOT), extending 10 mm down from the aortic annulus plane; (2) the upper LVOT, extending 2 mm down from the annulus plane; and (3) the aortic valve region. RESULTS: Calcium volumes in the upper LVOT (median, 29 vs 0 mm(3); P < .0001) and overall LVOT (median, 74 vs 3 mm(3); P = .0001) were higher in patients who experienced aortic root injury compared with the control group. Calcium in the aortic valve region did not differ between groups. Upper LVOT calcium volume was more predictive of aortic root injury than overall LVOT calcium volume (area under receiver operating curve [AUC], 0.78; 95% confidence interval, 0.69-0.86 vs AUC, 0.71; 95% confidence interval, 0.62-0.82; P = .010). Upper LVOT calcium below the noncoronary cusp was significantly more predictive of aortic root injury compared to calcium underneath the right coronary cusp or the left coronary cusp (AUC, 0.81 vs 0.68 vs 0.64). Prosthesis oversizing >20% (likelihood ratio test, P = .028) and redilatation (likelihood ratio test, P = .015) improved prediction of aortic root injury by upper LVOT calcium volume. CONCLUSION: Calcification of the LVOT, especially in the upper LVOT, located below the noncoronary cusp and extending from the annular region, is predictive of aortic root injury during TAVR with a balloon-expandable valve.
BACKGROUND: A detailed assessment of calcium within the aortic root may provide important additional information regarding the risk of aortic root injury during transcatheter heart valve replacement (TAVR). OBJECTIVE: We sought to delineate the effect of calcium volume and distribution on aortic root injury during TAVR. METHODS: Thirty-three patients experiencing aortic root injury during TAVR with a balloon-expandable valve were compared with a control group of 153 consecutive TAVR patients without aortic root injury (as assessed by post-TAVR multidetector CT). Using commercial software to analyze contrast-enhanced pre-TAVR CT scans, calcium volume was determined in 3 regions: (1) the overall left ventricular outflow tract (LVOT), extending 10 mm down from the aortic annulus plane; (2) the upper LVOT, extending 2 mm down from the annulus plane; and (3) the aortic valve region. RESULTS:Calcium volumes in the upper LVOT (median, 29 vs 0 mm(3); P < .0001) and overall LVOT (median, 74 vs 3 mm(3); P = .0001) were higher in patients who experienced aortic root injury compared with the control group. Calcium in the aortic valve region did not differ between groups. Upper LVOT calcium volume was more predictive of aortic root injury than overall LVOT calcium volume (area under receiver operating curve [AUC], 0.78; 95% confidence interval, 0.69-0.86 vs AUC, 0.71; 95% confidence interval, 0.62-0.82; P = .010). Upper LVOT calcium below the noncoronary cusp was significantly more predictive of aortic root injury compared to calcium underneath the right coronary cusp or the left coronary cusp (AUC, 0.81 vs 0.68 vs 0.64). Prosthesis oversizing >20% (likelihood ratio test, P = .028) and redilatation (likelihood ratio test, P = .015) improved prediction of aortic root injury by upper LVOT calcium volume. CONCLUSION: Calcification of the LVOT, especially in the upper LVOT, located below the noncoronary cusp and extending from the annular region, is predictive of aortic root injury during TAVR with a balloon-expandable valve.
Authors: Won-Keun Kim; Johannes Blumenstein; Christoph Liebetrau; Andreas Rolf; Luise Gaede; Arnaud Van Linden; Mani Arsalan; Mirko Doss; Jan G P Tijssen; Christian W Hamm; Thomas Walther; Helge Möllmann Journal: Clin Res Cardiol Date: 2017-08-09 Impact factor: 5.460
Authors: Roberto Scarsini; Giovanni L De Maria; Jubin Joseph; Lampson Fan; Thomas J Cahill; Rafail A Kotronias; Francesco Burzotta; James D Newton; Rajesh Kharbanda; Bernard Prendergast; Flavio Ribichini; Adrian P Banning Journal: J Am Heart Assoc Date: 2019-09-14 Impact factor: 5.501