Key result
An increase in right and left coronary leaflet calcium (per 100 Agatston units) was associated with an increased risk of paravalvular regurgitation, but not permanent pacemaker insertion.
Why the study?
Complication rates of PVR and permanent pacemaker insertion remain high after TAVI for severe aortic stenosis, leading to interest in how individual leaflet calcium distribution affects these risks.
Does individual aortic valve leaflet calcification predict paravalvular regurgitation and permanent pacemaker insertion in patients undergoing trans-catheter aortic valve insertion?
Observational (n=251)
Does individual aortic valve leaflet calcification predict paravalvular regurgitation and permanent pacemaker insertion in patients undergoing trans-catheter aortic valve insertion?
Individual aortic valve leaflet calcification scores are associated with an increased risk of paravalvular regurgitation and need for post-implantation balloon aortic valvuloplasty, but not permanent pacemaker insertion, following TAVI.
Leaflet calcium scoring may refine pre-TAVI regurgitation risk stratification; leaves open incremental value beyond total Agatston score in prospective studies.
BACKGROUND: Complication rates of paravalvular aortic regurgitation (PVR) and permanent pacemaker insertion remain high in patients undergoing trans-catheter aortic valve insertion for severe aortic stenosis. The spatial distribution of calcium between individual aortic valve leaflets, and its potential role in these complications is gaining interest. We aimed to assess the accuracy of individual aortic valve leaflet calcium quantification, and to determine its effect on the frequency of these complications. METHODS: This was a retrospective study of 251 patients who underwent trans-catheter aortic valve insertion using the Evolut RTM valve. The off-line Terarecon software platform was used for Agatston scoring the short axis views. RESULTS: There was a correlation between the sum of the individual leaflet and the total aortic valve calcium score. There was a univariate association between an increase [per 100 Agatston unit (AU)] in both right coronary leaflet (RCL) and left coronary leaflet (LCL) calcium with the risk of PVR. There was an association between an increase in LCL calcium score (per 100 AU) and need for post-implantation balloon aortic valvuloplasty (BAV). There was no association between individual leaflet calcification on the risk of permanent pacemaker insertion. CONCLUSIONS: This study supports the idea that a quantifiable and reproducible method of individual valve leaflet calcification score may serve as an independent risk factor for paravalvular regurgitation, beyond visual assessment of asymmetry. However, the same may not be true of spatial calcium distribution and permanent pacemaker implantation (PPI).
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Mahon et al. (2021) conducted an observational in Severe aortic stenosis (n=251). Individual aortic leaflet calcification was evaluated on Paravalvular regurgitation and permanent pacemaker insertion. An increase in right and left coronary leaflet calcium (per 100 Agatston units) was associated with an increased risk of paravalvular regurgitation, but not permanent pacemaker insertion.
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