807 Comparison of 30-Day Outcomes Between Balloon-Expandable and Self-Expanding Transcatheter Heart Valves in Patients With Moderate or Severe Device Landing Zone Calcification

Abstract

Patients undergoing TAVI who have a significant volume of calcium at the device landing zone (DLZ) have been shown to have a high risk of death, annular rupture and paravalvular leak. Self-expanding (SE) valves have predominantly been used in this patient cohort due to a perceived reduced risk of annular rupture. A recently published propensity-matched cohort study of the French TAVI registry suggested that balloon expanding valves have lower rates of device related complications. A retrospective study comparing 30-day TAVI outcomes between balloon-expandable (BE) and SE valves in patients with moderate or severe device landing zone calcification (DLZC) as defined by SCCT guidelines. The endpoint was a composite of death, stroke, >mild PVL, urgent surgery, annular rupture or second valve deployed. A total of 120 patients (Mean age 82.3±9.2 with 46.7% female) with moderate or severe DLZC were included. 16.7% (20) patients were treated with SE valves. 35% (7/20) of SE valves were post dilated. BE valves had a lower 30-composite endpoint (BE 10% vs SE 45%, p<0.0001). 27 of the 120 patients (22.5%) had severe DLZC. In severe DLZC, the composite endpoint in both groups increased: BE valves 15.8% (3/19); SE valves 50% (4/8). No difference in pacemaker rates was observed. This is the first comparison of TAVI valves in moderate or severely calcified device landing zones. Balloon expandable valves were found to provide a lower rate of early valve related complications than self-expanding valves. This supports recent registry findings however, randomised data is needed.