535 CT SCAN AORTIC VALVE CALCIFICATION PATTERNS AND HEMODYNAMIC PERFORMANCE OF SELF-EXPANDING INTRA-ANNULAR TRANSCATHETER PROSTHESES

Abstract

Abstract Introduction Aortic valve calcification (AVC) represents a negative prognostic factor in patients undergoing transcatheter aortic valve implantation (TAVI). Recent randomized clinical trials comparing commercially available self-expanding (SE) supra-annular and balloon-expandable (BE) devices with second-generation SE intra-annular devices demonstrated the clinical non-inferiority of the latter in terms of procedural success. However, no current data are available in vivo regarding the potential impact of AVC on SE intra-annular device performance and clinical outcomes. Purpose to evaluate the potential impact of different AVC patterns on SE intra-annular device performance in a consecutive cohort of patients undergoing TAVI. Methods this is an observational, non-randomized, prospective, single-center study preliminarily enrolling 53 consecutive patients who underwent TAVI with a SE intra-annular device (Portico - Abbott Structural Heart, St Paul, MN, USA) between 2019 and 2022 at our department. All patients underwent transthoracic echocardiography, contrast-enhanced multidetector row computed tomography (MDCT) with volumetric calcium score and coronary angiography before TAVI. Patients with bicuspid aortic valve and previous surgical aortic valve replacement eligible for valve-in-valve TAVI were excluded. AVC and left ventricle outflow tract (LVOT) calcification (up to 15 mm below the basal annular plane) were quantified in the contrast images by using a Hounsfield unit threshold of 850. Results Patients undergoing post-TAVI pacemaker implantation (19% of the overall study population) had higher AVC levels compared with those that did not show this complication (all three cusps AVA calcium score 270.6±409.6 vs 158.1±137.1, p=0.146; p=0.048, p=0.181 and p=0.346 for left cusp- LCC, right cusp – RCC- and non-coronary cusp-NCC, respectively). Severe LVOT calcification was also associated with a higher incidence of AV conduction abnormalities (37.9±44.5 vs 13.4±39.0 of patients without AV defects, p=0.045). Moreover, post-procedural moderate/severe aortic regurgitation occurred more frequently in patients with LCC calcification (183.7±87.0 vs 64.2±99.6, p=0.018) and RCC calcification (188.7±149.5 vs 58.7±120.8, p=0.019) rather than those with NCC or LVOT calcification. Conclusion(s) preliminary results of our observational registry highlight the potential impact of AVC patterns on the occurrence of aortic regurgitation and pacemaker implantation after a SE intra-annular device. A larger sample size is needed to better understand the impact of calcium patterns on each single outcome in order to identify patients at higher risk and to early manage these complications, improving long-term outcomes.