Author + information
- Ahmad Agha,
- Nisreen Ali,
- Shermeen Memon,
- Lara Bakhos,
- Khaled Dajani,
- Mark Rabbat,
- Ferdinand Leya and
- Mushabbar Syed
Background: Transcatheter aortic valve replacement (TAVR) is being increasingly used in high-risk patients with severe aortic stenosis. Paravalvular aortic regurgitation (PAR) is frequently seen after TAVR and is associated with adverse clinical outcomes. We hypothesize that severity of aortic valve calcification leads to the development of PAR by preventing complete expansion of the self-expanding prosthetic aortic valve (CoreValve).
Methods: We performed a prospective study to evaluate the severity of aortic valve calcification and its impact on PAR in patients undergoing TAVR at a tertiary care academic medical center. Between 2009 and 2015, 85 patients underwent cardiac CT for quantitation of aortic valve calcification by Agatston score. PAR was assessed by post TAVR echocardiography. Patients were followed for 12 months for clinical outcomes.
Results: The mean age was 79.6 ± 9.6 years with 52% males. The mean aortic valve area was 0.7 ± 0.2cm2 with a mean gradient of 44 ± 16mmHg prior to and 13 ± 12mmHg after TAVR. The mean aortic valve calcium score was 2755 ± 1623. PAR was observed in 46 (54%) patients; mild 30 (35%); moderate 13 (15%); severe 3 (3.5%). Pre-procedure aortic valve calcium score was significantly associated with post-TAVR PAR (p = 0.05 for ≥mild PAR and p= 0.02 for ≥ moderate PAR). For 1 unit increase in calcium score the odds of having any degree of PAR within 100 days increased by 0.03% (p = 0.04) and the odds of having ≥moderate PAR increased by 0.04% (p = 0.01). During 12 month follow-up, 13 (15%) patients had heart failure and 15 (18%) patients died. No association was found between aortic valve calcium score and clinical outcomes, however, the study was not powered for this analysis.
Conclusions: Severity of aortic valve calcification is directly related to the development of PAR. Further studies are needed to assess its value in predicting procedural and clinical outcomes for patients undergoing TAVR.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Non Invasive Imaging: Expanding Clinical Applications
Abstract Category: 27. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography
Presentation Number: 1161-231
- 2017 American College of Cardiology Foundation