Background: Transcatheter aortic valve implantation (TAVI) is the mainstay for treating patients with severe aortic valve stenosis. The impact of calcium deposition in patients undergoing TAVI is not thoroughly investigated.
Purpose: We investigated the effect of aortic valve calcification in the clinical outcomes of patients undergoing TAVI with a self-expanding valve.
Methods: TAVI with a self-expanding bioprosthesis was performed in 175 high-risk patients with symptomatic severe aortic stenosis (age: 81±7 years; logistic EuroSCORE 22±8%; 56% females; NYHA III 90%). Patients with severe pre TAVI aortic regurgitation and bicuspid aortic valve disease were excluded. All patients underwent multislice computed tomography and all of them had calcium evaluation in a semi-quantitative way. The patients were then categorized into 3 groups according to the aortic valve's calcium deposition; group 1 had mild calcium, group 2 had moderate calcium deposition and group 3 had severe calcium deposition. All endpoints were considered as per the VARC-2 criteria.
Results: The total cohort was comprised of 175 patients, group 1 had 69 patients (39%), group 2 had 64 patients (37%) and group 3 had 42 (24%). Device success was similar among the groups (88% in group 1 vs 85% in group 2 vs 81% in group 3, p=0.15) and so was fluoroscopy time (23min in group 1 vs 25 min in group 2 vs 25 in group 3, p=0.54). Group 3 had higher rates of paravalvular leakage (PVL) after TAVI compared to the other groups. More specifically, patients in group 3 had higher rates of moderate/severe PVL (33% vs 19% in group 2 vs 8% in group 1, p=0.027 for all calculations). Patients in group 3 had higher new pacemaker implantation rates post TAVI compared to the other groups (40% vs 37% in group 2 vs 20% in group 1, p=0.032). Patients in group 3 had higher, although non-statistical significant stroke rates (4.8% vs 1.6% in group 2 vs 0% in group 1, p=0.141). Two-year mortality was similar among the groups (12% in group 1 vs 5.5% in group 2 vs 9.5% in group 3, p=0.39). In multivariate analysis, severe calcium deposition was proved to be an independent predictor of moderate/severe PVL post TAVI (p=0.002, OR 5.8, 95% CI 1.9–17.7).
Conclusion: Increased deposition of calcium in the aortic valve confers an adverse effect in patients undergoing TAVI with a self-expanding valve without effect in long-term mortality.