Calcification of the aortic valve as a possible predictor of paraprosthetic regurgitation after transcatheter aortic valve implantation

Abstract

Introduction. The development of paraprosthetic regurgitation after transcatheter aortic valve implantation (TAVI) in patients with critical aortic stenosis is an actual problem, which predictors are not well understood. One of the main reasons is calcification of the aortic valve, which does not allow the aortic valve prosthesis to fully expand.Objective – to identify a possible relationship between the severity of aortic valve calcification and the degree of paraprosthetic regurgitation after TAVI.Materials and methods. The study included 23 patients with critical symptomatic aortic stenosis and high risk factors for EuroScore II and STS. The single center study is a retrospective analysis of aortic valve calcification measured by preoperative multislice computed tomography. Calcification (calcium index) of the aortic valve was quantified according to the Agatson method. Paraprosthetic regurgitation was evaluated by transthoracic echocardiography according to the ACC/AHA recommendations. The observation period was 12 months. Results. There female patients predominated in the study group (n=15, 65 %). The mean value of the calcium index (CI) of the aortic valve was 5179.7±2334.1 Agatson units. Intraoperatively, half of the patients (n=12, 52 %) after implantation of aortic valve prosthesis had paraprosthetic regurgitation of more than II degree, which required postdilation. The calcium index in this group of patients was significantly higher (6088.3±2274.4, p=0.049). After implantation of an aortal valve prosthesis, paraprosthetic regurgitation of I–II degrees was observed in 16 patients (70 %) with a CI of 5902.1±2191.9, in 7 patients (30 %) with a CI of 3528.7±1537.2 paraprosthetic regurgitation was absent (p=0.021). In the postoperative period (12 months), no lethal outcomes were detected in the study group. Paraprosthetic regurgitation of I–II degrees was detected in 14 patients with a CI of 5676.6±2275, paraprosthetic regurgitation was absent in 9 patients with a CI of 4406.9±2338.3 (p=0.21).Conclusion. Patients with severe calcification of the aortic valve have an increased risk of developing significant paraprosthetic regurgitation and the use of more aggressive intervention techniques.