RF11 CALCIUM LOADING AS RISK FACTOR FOR POST IMPLANTATION LEAKAGE IN TAVI PROCEDURES

Abstract

Abstract Background and Aims: To assess aortic valve calcification with a reproducible method and the performance of different prostheses in relation to the occurrence of paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) in a large single-center cohort. Methods: We retrospectively analyzed preoperative contrast-enhanced CT scans of patients who underwent TAVI in our center between 2009 and 2016. Calcium volume was calculated for each aortic cusp in the aortic valve (AV), in the left ventricular outflow tract (LVOT) and device-landing zone (DLZ). Multivariate analysis was performed to evaluate the risk factors for intraoperative PVL. Results: 539 patients were included in the study (Edwards SapienXT, n = 192; Edwards Sapien3, n = 206; Medtronic CoreValve EvolutR, n = 44; Symetis Acurate, n = 97). Median calcium volume in the DLZ was 757 mm3 (IQR 734.2), with no significant differences among the four prosthesis groups. None of the patients had severe PVL. The overall incidence of mild-to-moderate PVL was 15.8%. On multiple linear regression analysis, DLZ calcification, non-coronary cusp in LVOT calcification, transapical access, and use of the CoreValve and Acurate prostheses were found to be independently associated with PVL. In contrast, degree of oversizing, and use of Sapien3 were independently associated with a lower incidence of PVL. Conclusions: DLZ and non-coronary cusp in LVOT calcification are independently associated with PVL occurrence after TAVI. Among prostheses, Sapien3 seems to be associated with a lower incidence of PVL regardless of calcium volume.