Abstract
Low-flow low-gradient severe aortic stenosis (LFLGAS) is associated with worse outcomes. Aortic valve calcification patterns of LFLGAS as compared to non-LFLGAS have not yet been thoroughly assessed. 137 patients undergoing transcatheter aortic valve replacement (TAVR) with preprocedural multidetector computed tomography (MDCT) and postprocedural transthoracic echocardiography were enrolled. Calcification characteristics were assessed by MDCT both for the total aortic valve and separately for each leaflet. 34 patients had LFLGAS and 103 non-LFLGAS. Total aortic valve calcification volume (p < 0.001), mass (p < 0.001), and density (p = 0.004) were lower in LFLGAS as compared to non-LFLGAS patients. At 30-day follow-up, mean transaortic pressure gradients and more than mild paravalvular regurgitation did not differ between groups. In conclusion, LFLGAS and non-LFLGAS express different calcification patterns which, however, did not impact on device success after TAVR.
Highlights
Severe aortic stenosis (AS) is the most frequent valvular heart disease in the Western society [1, 2], and surgical aortic valve replacement (SAVR) has been the standard treatment once symptoms appear [3, 4]
SAVR has been associated with better clinical outcomes compared to medical management in low-flow lowgradient severe aortic stenosis (LFLGAS) [7, 8], the associated surgical risk may be prohibitive, and transcatheter aortic valve replacement (TAVR) has become a less invasive treatment option in high-risk patients [3, 9,10,11]
Aortic valve calcifications have extensively been studied in patients undergoing TAVR, and annular assessment is mostly based on multidetector computed tomography (MDCT) or transesophageal echocardiography [12, 13]
Summary
Severe aortic stenosis (AS) is the most frequent valvular heart disease in the Western society [1, 2], and surgical aortic valve replacement (SAVR) has been the standard treatment once symptoms appear [3, 4]. SAVR has been associated with better clinical outcomes compared to medical management in LFLGAS [7, 8], the associated surgical risk may be prohibitive, and transcatheter aortic valve replacement (TAVR) has become a less invasive treatment option in high-risk patients [3, 9,10,11]. Aortic valve calcifications have extensively been studied in patients undergoing TAVR, and annular assessment is mostly based on multidetector computed tomography (MDCT) or transesophageal echocardiography [12, 13]. There exists only few data about calcification patterns in patients with LFLGAS [16], and comparisons among different types of AS disease entities have not been performed yet
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