TY - JOUR
T1 - The impact of calcium volume and distribution in aortic root injury related to balloon-expandable transcatheter aortic valve replacement
AU - Hansson, Nicolaj C.
AU - Nørgaard, Bjarne L.
AU - Barbanti, Marco
AU - Nielsen, Niels Erik
AU - Yang, Tae Hyun
AU - Tamburino, Corrado
AU - Dvir, Danny
AU - Jilaihawi, Hasan
AU - Blanke, Phillip
AU - Makkar, Raj R.
AU - Latib, Azeem
AU - Colombo, Antonio
AU - Tarantini, Giuseppe
AU - Raju, Rekha
AU - Wood, David
AU - Andersen, Henning R.
AU - Ribeiro, Henrique B.
AU - Kapadia, Samir
AU - Min, James
AU - Feuchtner, Gudrun
AU - Gurvitch, Ronen
AU - Alqoofi, Faisal
AU - Pelletier, Marc
AU - Ussia, Gian Paolo
AU - Napodano, Massimo
AU - Sandoli de Brito, Fabio
AU - Kodali, Susheel
AU - Pache, Gregor
AU - Canovas, Sergio J.
AU - Berger, Adam
AU - Murphy, Darra
AU - Svensson, Lars G.
AU - Rodés-Cabau, Josep
AU - Leon, Martin B.
AU - Webb, John G.
AU - Leipsic, Jonathon
N1 - Publisher Copyright:
© 2015 Society of Cardiovascular Computed Tomography.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - Background: A detailed assessment of calcium within the aortic root may provide important additional information regarding the risk of aortic root injury during transcatheter heart valve replacement (TAVR). Objective: We sought to delineate the effect of calcium volume and distribution on aortic root injury during TAVR. Methods: Thirty-three patients experiencing aortic root injury during TAVR with a balloon-expandable valve were compared with a control group of 153 consecutive TAVR patients without aortic root injury (as assessed by post-TAVR multidetector CT). Using commercial software to analyze contrast-enhanced pre-TAVR CT scans, calcium volume was determined in 3 regions: (1) the overall left ventricular outflow tract (LVOT), extending 10 mm down from the aortic annulus plane; (2) the upper LVOT, extending 2 mm down from the annulus plane; and (3) the aortic valve region. Results: Calcium volumes in the upper LVOT (median, 29 vs 0 mm3; P <.0001) and overall LVOT (median, 74 vs 3 mm3; P =0001) were higher in patients who experienced aortic root injury compared with the control group. Calcium in the aortic valve region did not differ between groups. Upper LVOT calcium volume was more predictive of aortic root injury than overall LVOT calcium volume (area under receiver operating curve [AUC], 0.78; 95% confidence interval, 0.69-0.86 vs AUC, 0.71; 95% confidence interval, 0.62-0.82; P =010). Upper LVOT calcium below the noncoronary cusp was significantly more predictive of aortic root injury compared to calcium underneath the right coronary cusp or the left coronary cusp (AUC, 0.81 vs 0.68 vs 0.64). Prosthesis oversizing >20% (likelihood ratio test, P =028) and redilatation (likelihood ratio test, P =015) improved prediction of aortic root injury by upper LVOT calcium volume. Conclusion: Calcification of the LVOT, especially in the upper LVOT, located below the noncoronary cusp and extending from the annular region, is predictive of aortic root injury during TAVR with a balloon-expandable valve.
AB - Background: A detailed assessment of calcium within the aortic root may provide important additional information regarding the risk of aortic root injury during transcatheter heart valve replacement (TAVR). Objective: We sought to delineate the effect of calcium volume and distribution on aortic root injury during TAVR. Methods: Thirty-three patients experiencing aortic root injury during TAVR with a balloon-expandable valve were compared with a control group of 153 consecutive TAVR patients without aortic root injury (as assessed by post-TAVR multidetector CT). Using commercial software to analyze contrast-enhanced pre-TAVR CT scans, calcium volume was determined in 3 regions: (1) the overall left ventricular outflow tract (LVOT), extending 10 mm down from the aortic annulus plane; (2) the upper LVOT, extending 2 mm down from the annulus plane; and (3) the aortic valve region. Results: Calcium volumes in the upper LVOT (median, 29 vs 0 mm3; P <.0001) and overall LVOT (median, 74 vs 3 mm3; P =0001) were higher in patients who experienced aortic root injury compared with the control group. Calcium in the aortic valve region did not differ between groups. Upper LVOT calcium volume was more predictive of aortic root injury than overall LVOT calcium volume (area under receiver operating curve [AUC], 0.78; 95% confidence interval, 0.69-0.86 vs AUC, 0.71; 95% confidence interval, 0.62-0.82; P =010). Upper LVOT calcium below the noncoronary cusp was significantly more predictive of aortic root injury compared to calcium underneath the right coronary cusp or the left coronary cusp (AUC, 0.81 vs 0.68 vs 0.64). Prosthesis oversizing >20% (likelihood ratio test, P =028) and redilatation (likelihood ratio test, P =015) improved prediction of aortic root injury by upper LVOT calcium volume. Conclusion: Calcification of the LVOT, especially in the upper LVOT, located below the noncoronary cusp and extending from the annular region, is predictive of aortic root injury during TAVR with a balloon-expandable valve.
KW - Aortic root calcification
KW - Aortic root injury
KW - Multidetector computed tomography
KW - Transcatheter aortic valve replacement
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U2 - 10.1016/j.jcct.2015.04.002
DO - 10.1016/j.jcct.2015.04.002
M3 - Article
C2 - 26164109
AN - SCOPUS:84941733498
SN - 1934-5925
VL - 9
SP - 382
EP - 392
JO - Journal of Cardiovascular Computed Tomography
JF - Journal of Cardiovascular Computed Tomography
IS - 5
ER -