Abstract 14481: Impact of Aortic Root Calcification Volume on Clinical Outcomes After Transcatheter Aortic Valve Implantation
Objectives: This study sought to evaluate the impact of aortic root calcification volume on clinical outcome after transcatheter aortic valve implantation (TAVI).
Background: Little data is available about whether aortic root calcification may impact the outcomes after TAVI.
Methods and Results: The term ‘aortic root’ refers to the aortic valve from its insertion at the left ventricular outlet to the sino-tubular junction. Multidetector row computed tomography (MDCT) has been shown to be a very simple and reliable tool to quantify the amount of calcifications. A total of 222 TAVI patients (aged 83.4±7.1 years, Logistic EuroSCORE 19.4±11.8) with preprocedural MDCT were studied. The Edwards valve was used in 162 (73.0%) patients and the CoreValve in 60. Aortic root calcification volume was measured using MDCT and a Valve Calcification Index (VCI) was defined as calcification volume (mm3)/ aortic annulus area (mm2). VCI (hazard ratio [HR] 2.10, 95% confidence interval [CI] 1.34 to 3.26, p<0.01) and baseline ejection fraction (HR 0.96, 95% CI 0.93 to 0.99, p=0.02) were identified by multivariate analysis as the only independent predictors of 30-day mortality after Edwards valve implantation. A VCI threshold of 2.05 (area under the curve 0.71, p<0.01) predicted a higher incidence of annulus rupture (10.5 vs 0.9%, p=0.01) and cardiac tamponade (14.6 vs 1.9%, p<0.01), lower device success (80.0 vs 98.2%, p<0.01) and 30-day survival rate (79.2 vs 95.4%, p<0.01) after Edwards valve implantation. Clinical outcomes after CoreValve implantation were not influenced by the VCI.
Conclusions: Valve calcification as assessed my MDCT using aortic root calcification volume indexed by annulus size (VCI) is a predictor of worse outcome after Edwards valve implantation, mainly related to annulus rupture. This VCI does not influence clinical outcomes after CoreValve implantation. Application of VCI may help improve valve selection.
- © 2013 by American Heart Association, Inc.