Association of aortic valve calcification severity with the degree of aortic regurgitation after transcatheter aortic valve implantation

Background: This study sought to examine a possible relationship between the severity of aortic valve calcification (AVC), the distribution of AVC and the degree of aortic valve regurgitation (AR) after transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS). Methods: 57 patients (22men, 81 +/- 5 years) with symptomatic AS and with a logistic EuroSCORE of 24 +/- 12 were included. 38 patients (67%) received a third (18F)-generation CoreValve (R) aortic valve prosthesis, in 19 patients (33%) an Edwards SAPIEN (TM) prosthesis was implanted. Prior to TAVI dual-source computed tomography for assessment of AVC was performed. To determine the distribution of AVC the percentage of the calcium load of the most severely calcified cusp was calculated. After TAVI the degree of AR was determined by angiography and echocardiography. The severity of AR after TAVI was related to the severity and distribution of AVC. Results: There was no association between the distribution of AVC and the degree of paravalvular AR after TAVI as assessed by angiography (r=-0.02, p=0.88). Agatston AVC scores were significantly higher in patients with AR grade >= 3 (5055 +/- 1753, n=3) than in patients with AR grade < 3 (1723 +/- 967, p=0.03, n=54). Agatston AVC scores>3000 were associated with a relevant paravalvular AR and showed a trend for increased need for second manoeuvres. There was a significant correlation between the severity of AVC and the degree of AR after AVR (r=0.50, p<0.001). Conclusion: Patients with severe AVC have an increased risk for a relevant AR after TAVI as well as a trend for increased need for additional procedures. (C) 2010 Elsevier Ireland Ltd. All rights reserved.