Universität zu Köln

Mauri, Victor, Frohn, Thomas, Deuschl, Florian, Mohemed, Kawa, Kuhr, Kathrin, Reimann, Andreas, Koerber, Maria Isabel, Schofer, Niklas, Adam, Matti, Friedrichs, Kai, Kuhn, Elmar W., Scholtz, Smita, Rudolph, Volker, Wahlers, Thorsten C. W., Baldus, Stephan, Mader, Navid, Schafer, Ulrich and Rudolph, Tanja K. (2020). Impact of device landing zone calcification patterns on paravalvular regurgitation after transcatheter aortic valve replacement with different next-generation devices. Open Heart, 7 (1). LONDON: BMJ PUBLISHING GROUP. ISSN 2053-3624

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Abstract

Objective Residual paravalvular regurgitation (PVR) has been associated to adverse outcomes after transcatheter aortic valve replacement (TAVR). This study sought to evaluate the impact of device landing zone (DLZ) calcification on residual PVR after TAVR with different next-generation transcatheter heart valves. Methods 642 patients underwent TAVR with a SAPIEN 3 (S3; n=292), ACURATE neo (NEO; n=166), Evolut R (ER; n=132) or Lotus (n=52). Extent, location and asymmetry of DLZ calcification were assessed from contrast-enhanced CT imaging and correlated to PVR at discharge. Results PVR was >= moderate in 0.7% of S3 patients, 9.6% of NEO patients, 9.8% of ER patients and 0% of Lotus patients (p<0.001), and these differences remained after matching for total DLZ calcium volume. The amount of DLZ calcium was significantly related to the degree of PVR in patients treated with S3 (p=0.045), NEO (p=0.004) and ER (p<0.001), but not in Lotus patients (p=0.698). The incidence of PVR >= moderate increased significantly over the tertiles of DLZ calcium volume (p=0.046). On multivariable analysis, calcification of the aortic valve cusps, LVOT calcification and the use of self-expanding transcatheter aortic valve implantation (TAVI) prostheses emerged as predictors of PVR. Conclusions The susceptibility to PVR depending on the amount of calcium was mainly observed in self-expanding TAVI prostheses. Thus, DLZ calcification is an important factor to be considered in prosthesis selection for each individual patient, keeping in mind the trade-off between PVR reduction, risk of new pacemaker implantation and unfavourable valve ha emodynamics.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Mauri, Victor UNSPECIFIED UNSPECIFIED UNSPECIFIED Frohn, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Deuschl, Florian UNSPECIFIED UNSPECIFIED UNSPECIFIED Mohemed, Kawa UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuhr, Kathrin UNSPECIFIED UNSPECIFIED UNSPECIFIED Reimann, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Koerber, Maria Isabel UNSPECIFIED UNSPECIFIED UNSPECIFIED Schofer, Niklas UNSPECIFIED UNSPECIFIED UNSPECIFIED Adam, Matti UNSPECIFIED UNSPECIFIED UNSPECIFIED Friedrichs, Kai UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuhn, Elmar W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Scholtz, Smita UNSPECIFIED UNSPECIFIED UNSPECIFIED Rudolph, Volker UNSPECIFIED UNSPECIFIED UNSPECIFIED Wahlers, Thorsten C. W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Baldus, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Mader, Navid UNSPECIFIED UNSPECIFIED UNSPECIFIED Schafer, Ulrich UNSPECIFIED UNSPECIFIED UNSPECIFIED Rudolph, Tanja K. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-345791
DOI:	10.1136/openhrt-2019-001164
Journal or Publication Title:	Open Heart
Volume:	7
Number:	1
Date:	2020
Publisher:	BMJ PUBLISHING GROUP
Place of Publication:	LONDON
ISSN:	2053-3624
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PROSTHESIS-PATIENT MISMATCH; CLINICAL-OUTCOMES; EVOLUT R; IMPLANTATION; PREDICTORS; CALCIUM; ASSOCIATION; MANAGEMENT; SEVERITY; LOCATION Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/34579