Aortic Valve and Left Ventricular Outflow Tract Calcification as Predictors of Early Complications After Transcatheter Aortic Valve Implantation: A Prospective Single-Center Study

Q: What are the key findings of this study?

Aortic valve calcification score significantly predicted early post-TAVI complications, including paravalvular leak (AUC 0.70), high-grade AV block (AUC 0.66), and postimplantation dilatation (AUC 0.64).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Symptomatic severe aortic stenosis (n=95). Intervention: Aortic valve and left ventricular outflow tract (LVOT) calcification. Primary outcome: Paravalvular leak (> grade 2), high-grade AV block requiring PPM, and requirement for postimplantation balloon dilatation within 30 days (AUC 0.70 for PVL, AUC 0.66 for AV block, AUC 0.64 for dilatation, p=<0.01 for PVL, 0.02 for AV block, 0.03 for dilatation).

Q: What does this research mean for the field?

Preoperative aortic valve and left ventricular outflow tract calcification significantly predict early post-TAVI complications, including paravalvular leak, high-grade atrioventricular block, and the need for postimplantation balloon dilatation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the impact of aortic valve and left ventricular outflow tract (LVOT) calcification on early complications following transcatheter aortic valve implantation (TAVI).

A Bakr; Mansour Mohamed Mostafa; Attia Ms; Ahmad E. Mostafa; Diaa Kamal; Ayman Gad; Waseem Omar Ahmed; S.H. Khan; Muhammad Saad Reihan

doi:10.14740/cr2247

July 18, 2026Cardiology ResearchOpen Access

Aortic Valve and Left Ventricular Outflow Tract Calcification as Predictors of Early Complications After Transcatheter Aortic Valve Implantation: A Prospective Single-Center Study

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Key result

Higher aortic valve calcification score predicts early post-TAVI complications, led by paravalvular leak.

AUC 0.70 for PVL, AUC 0.66 for AV block, AUC 0.64 for dilatation
P<0.01 for PVL, 0.02 for AV block, 0.03 for dilatation
n=95

Figures

Why the study?

The prognostic implications of aortic valve and left ventricular outflow tract (LVOT) calcification following TAVI remain uncertain.

Does preoperative aortic valve and LVOT calcification predict early complications (PVL, high-grade AV block, post-dilatation) in patients undergoing TAVI?

Key Points

To evaluate the impact of aortic valve and left ventricular outflow tract (LVOT) calcification on early complications following transcatheter aortic valve implantation (TAVI).
Prospective single-center cohort study of 95 consecutive patients with symptomatic severe aortic stenosis who underwent TAVI between October 2021 and May 2024.
Preoperative aortic valve calcium score was measured with multidetector computed tomography (MDCT) using the Agatston method, and LVOT calcification was assessed semi-quantitatively.
Primary endpoints assessed within 30 days post-TAVI were paravalvular leak (PVL > grade 2), permanent pacemaker implantation (PPM) for high-grade atrioventricular (AV) block, and requirement for postimplantation balloon dilatation.
The mean aortic valve calcium score was 2,658 ± 1,799; post-procedure, 5.2% (5/95) of patients required PPM and 14.7% (14/95) experienced transient PVL > grade 2, which fully resolved after dilatation.
Aortic valve calcium score significantly predicted PVL (AUC = 0.70, P < 0.01; cut-off 2,206), high-grade AV block (AUC = 0.66, P = 0.02; cut-off 1,972), and postimplantation dilatation (AUC = 0.64, P = 0.03; cut-off 2,900).
LVOT calcification significantly predicted high-grade AV block (P = 0.027) in univariate analysis, though it was not associated with PVL or post-dilatation.

Study Design

Type

Cohort (n=95)

Multicenter

No

Structured PICO

Does preoperative aortic valve and LVOT calcification predict early complications (PVL, high-grade AV block, post-dilatation) in patients undergoing TAVI?

P

Population

95 older adults (mean age 73.1 years, 38.9% female) with symptomatic severe aortic stenosis undergoing TAVI, followed for 30 days.

E

Exposure

Preoperative assessment of aortic valve calcium score (Agatston method) and left ventricular outflow tract (LVOT) calcification via multidetector computed tomography (MDCT) prior to TAVI.

O

Outcome

Paravalvular leak (PVL > grade 2), permanent pacemaker implantation (PPM) for high-grade atrioventricular (AV) block, and requirement for postimplantation balloon dilatation assessed within 30 days after TAVI.safety

Main Result

Effect estimate: AUC 0.70 for PVL, AUC 0.66 for AV block, AUC 0.64 for dilatation

p-value: p=<0.01 for PVL, 0.02 for AV block, 0.03 for dilatation

Limitations

Single-center observational study with a relatively small sample size
Low number of clinical events, particularly high-grade AV block requiring PPM
Follow-up was limited to 30 days after TAVI
Predominantly treated with the Evolut R valve platform, limiting generalizability to other valves
LVOT calcification was assessed using a qualitative visual classification rather than quantitative measurements
Detailed regional analysis of calcification distribution was not systematically performed
Exclusion of patients who died during hospitalization or were lost to follow-up introduces potential selection bias
Limited number of conduction events restricting statistical power

Implication

Quantitative assessment of aortic valve and LVOT calcification via preprocedural CT reliably predicts early conduction disturbances and paravalvular leak after TAVI, aiding in risk stratification.

Abstract

Background: The prognostic implications of aortic valve and left ventricular outflow tract (LVOT) calcification following transcatheter aortic valve implantation (TAVI) are uncertain. The aim of the study was to assess the influence of aortic valve and LVOT calcification on early TAVI outcomes. Methods: From October 2021 to May 2024, in this single-center prospective cohort study, preoperative aortic valve calcium score via the Agatston method was determined by multidetector computed tomography (MDCT), and LVOT calcification was semi-quantitatively assessed in 95 consecutive symptomatic severe aortic stenosis patients who underwent TAVI. Primary endpoints assessed within 30 days after TAVI were paravalvular leak (PVL > grade 2), permanent pacemaker implantation (PPM) for high-grade atrioventricular (AV) block, and requirement for postimplantation balloon dilatation. Results: The mean calcium score was 2,658 ± 1,799. Five patients (5.2%) required PPM, and 14 (14.7%) developed transient PVL > grade 2, all of which improved after dilatation. The aortic valve calcium score was associated with PVL (area under the curve (AUC) = 0.70; P < 0.01), high-grade AV block (AUC = 0.66; P = 0.02), and postimplantation dilatation (AUC = 0.64; P = 0.03). LVOT calcification predicted high-grade AV block (P = 0.027). Conclusions: Quantitative LVOT and aortic valve calcification grading is a reliable predictor of early conduction and valvular dysfunction complications after TAVI and demonstrates the value of comprehensive preprocedural computed tomography (CT) imaging for procedural planning and risk stratification.

Discussion

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Cite This Study

Bakr et al. (2026) conducted a cohort in Symptomatic severe aortic stenosis (n=95). Aortic valve and left ventricular outflow tract (LVOT) calcification was evaluated on Paravalvular leak (> grade 2), high-grade AV block requiring PPM, and requirement for postimplantation balloon dilatation within 30 days (AUC 0.70 for PVL, AUC 0.66 for AV block, AUC 0.64 for dilatation, p=<0.01 for PVL, 0.02 for AV block, 0.03 for dilatation). Aortic valve calcification score significantly predicted early post-TAVI complications, including paravalvular leak (AUC 0.70), high-grade AV block (AUC 0.66), and postimplantation dilatation (AUC 0.64).

synapsesocial.com/papers/6a5dbad58bd453d3397abf31 https://doi.org/10.14740/cr2247

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Aortic Valve and Left Ventricular Outflow Tract Calcification as Predictors of Early Complications After Transcatheter Aortic Valve Implantation: A Prospective Single-Center Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Aortic Valve and Left Ventricular Outflow Tract Calcification as Predictors of Early Complications After Transcatheter Aortic Valve Implantation: A Prospective Single-Center Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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