Impact of burden and distribution of aortic valve calcification on the hemodynamic performance and procedural outcomes of a self-expanding, intra-annular transcatheter aortic valve system

Annunziata Nusca; Michele Mattia Viscusi; Simone Circhetta; Valeria Cammalleri; Fabio Mangiacapra; Elisabetta Ricottini; Rosetta Melfi; Paolo Gallo; Nino Cocco; Raffaele Rinaldi; Francesco Grigioni; Gian Paolo Ussia

doi:10.1007/s10554-024-03261-1

Impact of burden and distribution of aortic valve calcification on the hemodynamic performance and procedural outcomes of a self-expanding, intra-annular transcatheter aortic valve system

Int J Cardiovasc Imaging. 2024 Oct 21. doi: 10.1007/s10554-024-03261-1. Online ahead of print.

Authors

Annunziata Nusca^{1

2}, Michele Mattia Viscusi^{1

2}, Simone Circhetta^{1

2}, Valeria Cammalleri^{1

2}, Fabio Mangiacapra^{1

2}, Elisabetta Ricottini^{1

2}, Rosetta Melfi^{1

2}, Paolo Gallo^{1

2}, Nino Cocco^{1

2}, Raffaele Rinaldi^{1

2}, Francesco Grigioni^{1

2}, Gian Paolo Ussia^{3

4}

Affiliations

¹ Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy.
² Research Unit of Cardiac Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Roma, Italy.
³ Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy. g.ussia@unicampus.it.
⁴ Research Unit of Cardiac Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Roma, Italy. g.ussia@unicampus.it.

PMID: 39432134
DOI: 10.1007/s10554-024-03261-1

Abstract

Aortic valve calcification (AVC) has been explored as a powerful predictor of procedural complications in patients undergoing transcatheter aortic valve implantation (TAVI). However, little evidence exists on its impact on intra-annular devices' performance. We aimed to investigate the impact of AVC burden and distribution pattern on the occurrence of paravalvular leak (PVL), conduction disturbances requiring permanent pacemaker implantation (PPI) and 30-day clinical outcomes in patients undergoing TAVI with a self-expanding, intra-annular device. According to AVC, 103 patients enrolled in a single medical centre from November 2019 to December 2022 were divided into tertiles. Valve Academic Research Consortium (VARC)-3 definitions were used to classify procedural complications and outcomes. Patients in the highest AVC tertile showed an increased occurrence of mild or more PVL and conduction disorders (p < 0.001 and p = 0.006). AVC tertiles (highest tertile) emerged as an independent predictor of PVL (OR 7.32, 95%CI 3.10-17.28, p < 0.001) and post-TAVI conduction disturbances (OR 3.73, 95%CI 1.31-10.60, p = 0.013) but not of PPI (OR 1.44, 95%CI 0.39-5.35, p = 0.579). Considering calcium distribution, ROC analyses revealed that annular AVC but not left ventricle outflow tract (LVOT) calcium burden significantly indicated the development of PVL (AUC 0.863, 0.77-0.93, p < 0.001) and conduction disorders/PPI (AUC 0.797, 0.70-0.89, p < 0.001 and 0.723, 0.58-0.86, p = 0.018, respectively). After adjustment for age and sex, the highest tertile remained an independent predictor of the 30-day composite outcome (death, myocardial infarction, stroke, major vascular complications, type 3/4 bleedings, acute kidney injury, PPI and ≥ moderate PVL) (OR 3.26; 95%CI 1.26-8.40, p = 0.014). A higher AVC is associated with an increased risk of PVL and conduction disturbances after TAVI with a self-expanding, intra-annular device. However, our findings suggest a minor role for LVOT calcification compared with annular AVC in the performance of this specific prosthesis.

Keywords: Aortic valve calcification; Intra-annular device; Paravalvular leak; Permanent pacemaker implantation; Portico valve; Transcatheter aortic valve implantation.