J Cardiovasc Comput Tomogr. 2015 Sep-Oct;9(5):382-92. doi: 10.1016/j.jcct.2015.04.002. Epub 2015 Apr 18.
Hansson NC1, Nørgaard BL2, Barbanti M3, Nielsen NE4, Yang TH5, Tamburino C6, Dvir D7, Jilaihawi H8, Blanke P9, Makkar RR8, Latib A10, Colombo A10, Tarantini G11, Raju R7, Wood D7, Andersen HR2, Ribeiro HB12, Kapadia S13, Min J8, Feuchtner G14, Gurvitch R15, Alqoofi F16, Pelletier M17, Ussia GP18, Napodano M10, Sandoli de Brito F Jr19, Kodali S20, Pache G9, Canovas SJ21, Berger A7, Murphy D7, Svensson LG13, Rodés-Cabau J12, Leon MB20, Webb JG7, Leipsic J7.
BACKGROUND: A detailed assessment of calcium within the aortic root may provide important additional information regarding the risk of aortic root injury during transcatheter heart valve replacement (TAVR). OBJECTIVE: We sought to delineate the effect of calcium volume and distribution on aortic root injury during TAVR.
METHODS: Thirty-three patients experiencing aortic root injury during TAVR with a balloon-expandable valve were compared with a control group of 153 consecutive TAVR patients without aortic root injury (as assessed by post-TAVR multidetector CT). Using commercial software to analyze contrast-enhanced pre-TAVR CT scans, calcium volume was determined in 3 regions: (1) the overall left ventricular outflow tract (LVOT), extending 10 mm down from the aortic annulus plane; (2) the upper LVOT, extending 2 mm down from the annulus plane; and (3) the aortic valve region.
RESULTS: Calcium volumes in the upper LVOT (median, 29 vs 0 mm(3); P < .0001) and overall LVOT (median, 74 vs 3 mm(3); P = .0001) were higher in patients who experienced aortic root injury compared with the control group. Calcium in the aortic valve region did not differ between groups. Upper LVOT calcium volume was more predictive of aortic root injury than overall LVOT calcium volume (area under receiver operating curve [AUC], 0.78; 95% confidence interval, 0.69-0.86 vs AUC, 0.71; 95% confidence interval, 0.62-0.82; P = .010). Upper LVOT calcium below the noncoronary cusp was significantly more predictive of aortic root injury compared to calcium underneath the right coronary cusp or the left coronary cusp (AUC, 0.81 vs 0.68 vs 0.64). Prosthesis oversizing >20% (likelihood ratio test, P = .028) and redilatation (likelihood ratio test, P = .015) improved prediction of aortic root injury by upper LVOT calcium volume.
CONCLUSION: Calcification of the LVOT, especially in the upper LVOT, located below the noncoronary cusp and extending from the annular region, is predictive of aortic root injury during TAVR with a balloon-expandable valve.
Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.