Eccentric Valvular Calcification May Be Associated With Longitudinal THV Distortion

Eccentric calcification was found to be associated with longitudinal transcatheter heart valve (THV) distortion, according to a study published in the Journal of Interventional Cardiology.

This study aimed to examine the relationship between the degree and eccentricity of aortic valve calcification and THV distortion, as well as the impact of THV distortion on follow-up echo parameters and clinical outcomes after transcatheter aortic valve implantation (TAVI). A total of 118 patients (mean age, 83.6 ± 5.1 years; 35.6% men) with symptomatic severe aortic stenosis who were undergoing THV implantation were enrolled. Multislice computed tomography (MSCT) was conducted before and after the procedure, and transthoracic echocardiogram (TTE) was performed during the follow-up.

Delta calcium score (ΔCS) was defined as the difference between the maximum and minimal calcium scores of the 3 cusps. The valve distortion score (VDS) was the difference between the longest and shortest stent frame, measurements which were obtained with MSCT. Patients were categorized as having noneccentric or eccentric calcification (n=59 in each group), based on ΔCS.

The prevalence of chronic obstructive pulmonary disease was significantly higher in the eccentric vs noneccentric calcification group, and the rate of prior percutaneous coronary intervention was higher in the noneccentric calcification group.

VDS was significantly lower in the noneccentric vs eccentric calcification group (1.31 ± 0.82 mm vs 1.73 ± 0.76 mm, respectively; P =.004). In addition, VDS was not found to be associated with the degree of paravalvular leak (PVL) or aortic valvular mean pressure gradient (AVPG) at the 30-day and 1-year follow-ups. Longitudinal THV distortion was not found to affect the cumulative rates of adverse clinical events (all-cause death, rehospitalization, and valve thrombosis) at the 2-year clinical follow-up.

“The association between THV distortion due to eccentric calcification and THV durability is not well known,” noted the study authors. “This study revealed that THV maintains excellent functions regardless of longitudinal THV distortion in midterm follow-up TTE.”

Study limitations include its observational, single-center nature and small cohort.

“Eccentricity of aortic valvular calcification was associated with longitudinal, but not cross-sectional, distortion of the THV stent frame,” the researchers concluded. “However, this longitudinal THV distortion was not associated with the degree of PVL and AVPG, and clinical adverse events in midterm follow-up.”

Disclosures: One of the authors reported an affiliation with a medical device company. Please see the original reference for a full list of disclosures.

Reference

Nakajima A, Naganuma T, Yuki H, et al. The impact of aortic valvular calcium on transcatheter heart valve distortion [published online January 5, 2021]. J Interv Cardiol. doi: 10.1155/2021/8829906