Aortic valve calcium score for paravalvular aortic insufficiency (AVCS II) study in transapical aortic valve implantation

Authors

  • Martin Haensig Department of Cardiac Surgery, Heart Center of the University of Leipzig, Leipzig
  • Lukas Lehmkuhl Department of Interventional and Diagnostic Radiology, Heart Center of the University of Leipzig, Leipzig
  • Axel Linke Department of Cardiology, Heart Center of the University of Leipzig, Leipzig
  • Philipp Kiefer Department of Cardiac Surgery, Heart Center of the University of Leipzig, Leipzig
  • Chirojit Mukherjee Department of Anesthesia, Heart Center of the University of Leipzig, Leipzig
  • Gerhard Schuler Department of Cardiology, Heart Center of the University of Leipzig, Leipzig
  • Matthias Gutberlet Department of Interventional and Diagnostic Radiology, Heart Center of the University of Leipzig, Leipzig
  • Friedrich-Wilhelm Mohr Department of Cardiac Surgery, Heart Center of the University of Leipzig, Leipzig
  • David Holzhey Department of Cardiac Surgery, Heart Center of the University of Leipzig, Leipzig

DOI:

https://doi.org/10.1532/hsf.1399

Abstract

Background: Transapical aortic valve implantation (TAAVI) has evolved into a routine procedure for select high-risk patients. The aim was to study the impact of native aortic valve calcification on paravalvular leaks in cardiac contrast-enhanced computed tomography (CT).
Methods: The degree and distribution of valve calcification were quantified using an Aortic Valve Calcium Score (AVCS) for each cusp separately (3mensio Valves). To reduce an artificial increase of the AVCS due to the presence of contrast material, we used thresholds for density [mean aortic density + 2*SD] and volume [0, 3, 5, 25, and 50 mm3] of calcification.
Results: 111 consecutive patients prior to TAAVI with preoperative CT aged 79.8 ± 5.8 years were included using the Edwards Sapien prosthesis. Paravalvular leaks were significantly associated with eccentric calcified plaques (r [Spearman] = 0.37; χ2-statistic = 15.4; P = .002), presence of LVOT calcium (r [Spearman] = 0.28; χ2-statistic = 11.3; P = .009), and the commissural gap at the anatomic ventriculo-arterial junction (r [Spearman] = 0.41-0.63; χ2-statistic = 50.8-53.0;
P = .002-≤.001). There was no significant association between the total AVCS and PV leaks (r [Spearman] = 0.076; χ2-statistic = 1.471; P = .240, 120 kV, 850 hounsfield units) with no additional use of a volume-based threshold.
Conclusion: Asymmetry of leaflet calcium distribution, LVOT calcium, and the commissural gap between leaflets were significantly associated with paravalvular leaks. Moreover, quantification of aortic valve calcification in contrast enhanced CTs shows only a weak correlation with paravalvular leakage and is therefore not reliable as a predictor, respectively.

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Published

2016-02-24

How to Cite

Haensig, M., Lehmkuhl, L., Linke, A., Kiefer, P., Mukherjee, C., Schuler, G., Gutberlet, M., Mohr, F.-W., & Holzhey, D. (2016). Aortic valve calcium score for paravalvular aortic insufficiency (AVCS II) study in transapical aortic valve implantation. The Heart Surgery Forum, 19(1), E036-E042. https://doi.org/10.1532/hsf.1399

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