Abstract 16824: Aortic Valve Calcium Score as a Predictor For Periprocedural Complications and 1-Year Mortality After Tavi Using the Corevalve and the Sapien XT Device
Background: Percutaneous aortic valve replacement is a novel treatment option for patients with severe aortic stenosis and high risk for conventional surgery due to significant co morbidity. Risk scores for surgical valve replacement failed to accurately predict periprocedural MACE and 1-year mortality and there is an obvious lack of alternative parameters or scores to risk stratify candidates for TAVI.Objective: We sought to determine and analyze the amount of aortic valve calcification derived from preprocedural contrast enhanced CT-scans as a risk factor for subsequent adverse events.
Methods: The transfemoral TAVI procedure was performed in 68 patientsusing the CoreValve device and in 60 patients using the Edwards Sapien XT Device. All patients were refused for conventional surgery due to a high perioperative risk. In all patients the aortic valve calcium score was determined from preprocedural ECG-triggered 64-sclice CT scans.
Results: The 30-day MACE rate including death, Stroke and MI was 10.7%, one-year mortality was 11.2%. Using linear regression analysis the aortic valve calcium score turned out as the only significant predictor for 30-day MACE and for 1-year Mortality. Patients with a valve calcium score > 750 had a significant lower one- year survival rate compared to patients with scores <750 (56% vs. 95%, p<0.05). In the patient cohort treated with the CoreValve Device the valve calcium-score was strongly associated with the incidence and severity of postprocedural aortic regurgitation (r=0.26, p<0.05), whereas there was no such relation after treatment with the Sapien XT Device.
Conclusion: The aortic valve calcification score is significantly associated with severe procedural complications and one year mortality after TAVI. Large amounts of valve calcium pose a high risk for postprocedural aortic regurgitation in patients treated with the CoreValve system but not for patients treated with the balloon expandable Sapien XT device. Thus the aortic valve calcium score may be used for risk stratification before TAVI and may also help to guide the individual device selection in future.
- © 2011 by American Heart Association, Inc.