Abstract 14317: Impact of Aortic Valve and Annular Calcification on Paravalvular Aortic Regurgitation After Transcatheter Aortic Valve Replacement: A Real-Time Three-Dimensional Transesophageal Echocardiography Study
Backgrounds: Paravalvular aortic regurgitation (paraAR) is an important prognostic factor for patients after Transcatheter Aortic Valve Replacement (TAVR), but its determinants remain unclear. The purpose of this study was to investigate the impact of aortic valve and annular calcification on paraAR after TAVR using real-time three-dimensional transesophageal echocardiography (RT3D-TEE).
Methods: A total of 150 consecutive patients were evaluated who underwent TAVR using the Edwards SAPIEN and intraoperative 3DTEE. We assessed the severity of calcification on a visual scale from 0 to 3 at each three levels of aortic valve and in each cusp respectively: three levels were at aortic annulus, at leaflet just above annulus, and at commissure: scale definition as 0 of normal density; 1 of high echo density without acoustic shadow; 2 with mild acoustic shadow; 3 with strong acoustic shadow. In addition we assessed the shape and location of calcification, especially focusing on two observational features: (1) annular calcification protruding inward more than 3mm, or with circumferential distance more than 8mm (Figure), and (2) leaflet calcification existing below annulus or protruding into LVOT (Figure). ParaAR was assessed using TEE. Significant paraAR was defined as at least moderate degree.
Results: 22 patients (15%) with poor image quality of 3DE were excluded. We could successfully evaluate the whole annulus calcification including RCC side except in 18 patients (14%) with severe acoustic shadow. Significant paraAR occurred in 23 patients (18%). In multivariate analysis, independent predictors of significant paraAR were only the two calcification features of shape and location. All patients with one of two observational features had significant paraAR.
Conclusions: RT3D-TEE revealed that significant paraAR after TAVR was associated with the shape and location of calcification, not with its severity.
- © 2013 by American Heart Association, Inc.