Impact of aortic valve calcification severity on device success after transcatheter aortic valve replacement

AbstractAortic valvular calcium score (AVCS) can identify severe aortic stenosis (AS) and provide powerful prognostic information. In severe and symptomatic AS, patients can be referred for a transcatheter aortic valve replacement (TAVR). The aim of this study was to determine whether AVCS, measured on the preoperative contrast enhanced multislice computed tomography (MSCT), is associated with device success (DS), major adverse cardiac events (MACEs) and paravalvular leak (PVL) after TAVR. Three hundred and fifty-two consecutive patients who underwent TAVR with a preoperative standardised contrast enhanced MSCT were included in the study. Valvular calcification detection was defined by adding  + 100 Hounsfield Unit (HU) to mean HU determined by a region of interest placed in the contrast enhanced ascending aorta. AVCS was then indexed to the aortic annulus surface (AVCSi). Endpoints were DS and 30-day MACE according to Valve Academic Research Consortium-2 consensus document, and mode rate to severe PVL. DS was obtained for 305 patients. In multivariate analysis, AVCSi was negatively and independently associated with DS: OR = 0.99, 95% CI 0.99–0.99, p = 0.03. In the subgroup analysis, this association was particularly relevant with self-expanding prostheses [n = 151 (43%), p = 0.018] and in the cases of asymmetric calcium valvular distribution [n = 283 (80%), p 0.002]. There was no associ...
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research

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Authors: Erbel R Abstract The progress in cardiology during the last 50 years can best be studied by looking at the diagnostics and treatment of patients with aortic valve stenosis. Previously, the clinical examination, electrocardiography (ECG) and chest X‑ray were used before heart catheterization, which included a transseptal puncture to complete the indications for surgery in young patients. Nowadays, echocardiography, often combined with a dobutamine stress test, is the primary diagnostic tool to which computed tomography for quantification of valve calcification and cardiac magnetic resonance...
Source: Herz - Category: Cardiology Tags: Herz Source Type: research
Authors: Brito D, Goykhman I, Lo KB, Alhamshari Y, Peñalver JL, Aguilar F, Quintero E, Kalla A, Friend E, Pressman GS Abstract Aortic stenosis (AS) is common and increasing in prevalence as the population ages. Using computed tomography (CT) to quantify aortic valve calcification (AVC) it has been reported that men have greater degrees of calcification than women among subjects with severe AS. These data, however, were derived in largely Caucasian populations and have not been verified in non-Caucasian subjects. This retrospective study identified 137 patients with severe AS who underwent valve replacement a...
Source: Monaldi Archives for Chest Disease - Category: Respiratory Medicine Tags: Monaldi Arch Chest Dis Source Type: research
ConclusionPreoperative MDCT in patients undergoing SAVR is a useful tool for lifetime management, particularly in patients with tricuspid AS. Decisions for surgical management may change based on MDCT's ability to predict intraoperative SAVR size and determine which patients may be high ‐risk candidates for future ViV TAVR due to coronary artery obstruction.
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: ORIGINAL ARTICLE Source Type: research
A 71-year-old Jehovah ’s witness woman with a past medical history significant for diabetes mellitus, hypertension, breast cancer, aortic stenosis, and coronary artery disease underwent three-vessel coronary artery bypass graft (CABG) and surgical aortic valve replacement (SAVR) with a 19 mm Sorin Mitroflow (Sorin Grou p, CO, USA) (True internal diameter 15.4 mm). Severe patient prosthesis mismatch (PPM) (EOAi: 0.30 cm2/m2) was diagnosed shortly after surgery with post-operative mean gradients of 40 mmHg by echocardiography.
Source: Journal of Cardiovascular Computed Tomography - Category: Radiology Authors: Tags: Case report Source Type: research
Purpose: Identify a measurable parameter from test bolus of computed tomography angiography that can differentiate aortic stenosis patients with normal systolic function from those with heart failure and reduced ejection fraction (HFrEF). Materials and Methods: This retrospective study included patients (undergoing evaluation for transcatheter aortic valve replacement) who had retrospective electrocardiogram-gated cardiac computed tomography angiography using test bolus. The measured variables were time to peak contrast enhancement in the pulmonary artery (PAtime), in the ascending (AsAotime) and descending aorta (DsA...
Source: Journal of Thoracic Imaging - Category: Radiology Tags: Original Articles Source Type: research
AbstractTo investigate whether image reconstruction with iterative reconstruction (IR) affects aortic valve calcification (AVC) scoring and likelihood categorization of severe aortic stenosis (AS). In this IRB-approved retrospective study, we included 100 consecutive patients with AS (40 females; mean age 77  ± 10 years; age range: 36–99 years) undergoing CT prior to transcatheter aortic valve replacement. Non-enhanced, electrocardiography-gated CT of the heart was reconstructed with filtered back projection (FBP) and with advanced modeled IR at strength levels 1–5. AVC Agatston s...
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research
Conclusion Oversizing reduces the risk of device failure and intraprocedural postdilation but increases the risk of PPI. Early and midterm morbidity and mortality after OS and nOS with S3 are comparable. [...] Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text
Source: The Thoracic and Cardiovascular Surgeon - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Original Cardiovascular Source Type: research
1375Objectives: Aortic stenosis (AS) is the most common valve disease in the western world leading to significant health burden. Its incidence is projected to increase with the aging population and is estimated to affect nearly 1.4 million people over the age of 75 in the United States by 2025. AS is characterized by progressive thickening, fibrosis, and calcification of the leaflets leading to restricted valve opening, ultimately resulting in heart failure and death. Both AS and atherosclerosis have shared risk factors, however, there are no medications proven to attenuate or reverse stenosis progression, unlike atheroscl...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Cardiovascular Sciences (Poster Session) Source Type: research
Transcatheter aortic valve replacement (TAVR) has become the preferred treatment in patients with symptomatic severe aortic stenosis at high and intermediate risk. Multislice computed tomography is known to be the gold standard for cardiac three-dimensional (3D) reconstruction, annular sizing, and calcium-related risk stratification before TAVR. Three-dimensional transesophageal echocardiography (TEE) may be an alternative for annular sizing if multislice computed tomography is not available or in case of pronounced renal dysfunction.
Source: Journal of the American Society of Echocardiography - Category: Cardiology Authors: Source Type: research
CONCLUSION: Our outcomes indicated that the mean duration before TAVI or SAVR was reduced when malignant findings were detected by CT; and TAVI may be a safe and effective treatment for patients with aortic stenosis and a malignant tumor. PMID: 32364924 [PubMed - as supplied by publisher]
Source: The Heart Surgery Forum - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Heart Surg Forum Source Type: research
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