Original Title: Ballon-Expandable Trancatheter Aortic valve Replacement in Patients whit Extreme Aortic Valve Calcification.

Reference: Yigal Abramowitz, et al. Catetherization and Cardiovascular Intervention 2016;87:117-1179.

Courtesy of Dr. Carlos Fava.

Transcatheter aortic valve replacement (TAVI) emerged as a valid option to treat high risk inoperable patients. A group of these patients presents extreme valve calcification and outcomes remain unclear.

The study analyzed 299 undergoing TAVI with the Edwards-Sapiens or Sapiens XT valve. Extreme calcification was defined as >8,000 Agatston units in CT scan prior procedure.

From the total number of patients, 20 (6.7%) presented extreme calcification; this group had the elderly patients (84.9 ± 6.6 vs. 82.4 ± 8.2 years; p=0.1), more frequently men, with the highest mean and peak gradients (56.1/89.4 vs. 44.1/77.1 mmHg; p=0.02 for both), and CT scan showed larger aortic annulus and area.

Implantation success in this group with extreme calcification was lower (80% vs. 95.3% p=0.004), which required longer procedural and fluoroscopy time and larger contrast volume.

Paravalvular regurgitation was higher in the group with extreme calcification, researchers saw:

(p=0.01)

-50% no regurgitation

-35% mild regurgitation

-10% moderate

5% severe

Compared to the control group, that showed:

-72.4% no regurgitation

-25.8% mild regurgitation

-1.8% moderate

-0% severe

Rates of in-hospital evolution, 30 day mortality, the need for definite pacemaker and major complications were similar.

Follow up was at 16 months, with no difference in mortality or major complications.

Conclusion

Balloon expandable transcatheter aortic valve replacement in patients with extreme valve calcification is associated with lower implantation success rate and higher risk of paravalvular regurgitation.

 Editorial Comment

It has been shown extreme calcification reduces implantation success and increases paravalvular regurgitation which, when moderate or severe, is associated with lower technical success rate.

The limitation to this analyzis is that patients with severe calcification are limited in number and follow up is little longer than a year.

With the new valves currently available, implantation success and regurgitation may improve.

We need a larger study with longer follow up.

Courtesy of Dr. Carlos Fava. Fundación Favaloro. Buenos Aires, Argentina.

Your opinion matters to us. You are most welcome to leave your comment, reflection, question or any ideas down below.