eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
Current issue Archive Manuscripts accepted About the journal Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
vol. 14
Original paper

Quantitative estimation of aortic valve calcification in multislice computed tomography in predicting the development of paravalvular leaks following transcatheter aortic valve replacement

Małgorzata Ryś, Tomasz Hryniewiecki, Ilona Michałowska, Patrycjusz Stokłosa, Monika Różewicz-Juraszek, Zbigniew Chmielak, Maciej Dąbrowski, Kryspin Mirota, Piotr Szymański

Adv Interv Cardiol 2018; 14, 1 (51): 85–89
Online publish date: 2018/03/22
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
Transcatheter aortic valve implantation (TAVI) improves prognosis in patients disqualified from surgical valve replacement. Calcifications of the aortic complex can lead to deformation of the prosthesis, resulting in paravalvular leaks (PVL).

To evaluate the predictive value of quantitative estimation of volume/weight and geometric distribution of calcifications in multislice computed tomography, for the development of PVL.

Material and methods
This was a retrospective, case-control study on patients with a CoreValve aortic prosthesis. The study group consisted of 20 patients with confirmed significant PVL after TAVI. The control group consisted of 20 patients without significant PVL, matched according to valve type and clinical characteristics. The size spatial distribution and shape of calcifications were measured.

The average age of patients was 79.9 years (60% women). Cases and controls did not differ in their clinical characteristics. The size of the aortic annulus was significantly larger in cases vs. controls (23.4 ±1.6 vs. 22 ±1.4 mm, p = 0.01). Volume, area and curvature of calcifications were greater in cases vs controls (1.09 ±0.56 vs. 0.59 ±0.41 cm3, p = 0.011; 15.26 ±5.46 vs. 9.50 ±5.29 cm2, p = 0.008; 1.76 ±0.07 vs. 1.68 ±0.13 cm3, p = 0.037). In multivariate analysis, adjusted for aortic annulus size, the area of aortic valve calcifications independently predicted paravalvular regurgitation (OR = 1.41, 95% CI: 0.09–1.92, p < 0.009).

Morphometric analysis of aortic valve calcifications predicted the risk of paravalvular leak following TAVI irrespectively of patients’ clinical characteristics.


aortic stenosis, transcatheter aortic valve implantation, aortic regurgitation

Leon M, Mac M, Miller C, et al. Transcatheter aortic-valve implantation for aortic stenosis in patient who cannot undergo surgery, N Engl J Med 2010; 363: 1597-607.
Olasińska-Wiśniewska A, Grygier M, Lesiak M, et al. Przezcewnikowa implantacja zastawki aortalnej. Nowa szansa dla pa­cjentów wysokiego ryzyka ze stenozą aortalną. Folia Cardiol Excerpta 2011; 4: 227-35.
Bagienski M, Kleczynski P, Dziewierz A, et al. Early- and mid-term outcomes after transcatheter aortic valve implantation. Data from a single-center registry. Adv Interv Cardiol 2016; 12: 122-7.
Généreux P, Head S, Hahn R, et al. Paravalvular leak after transcatheter aortic valve replacement. The new Achilles’ heel? A comprehensive review of the literature. J Am Coll Cardiol 2013; 61: 1125-36.
Lerakis S, Hayek SS, Douglas PS, et al. Paravalvular aortic leak after transcatheter aortic valve replacement: current knowledge. Circulation 2013; 127: 397-407.
Kleczyński P, Zasada W, Bagieński M, et al. Paravalvular leak after transcatheter aortic valve implantation (TAVI): short-term results. Data from Polish national POL-TAVI registry. Cardiol J 2016; 23: 163-8.
Barbanti M, Yang TH, Rodès CJ, et al. Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement. Circulation 2013; 128: 244-53.
Détaint D, Lepage L, Himbert D, et al. Determinants of significant paravalvular regurgitation after transcatheter aortic valve: implantation impact of device and annulus discongruence. JACC Cardiovasc Interv 2009; 2: 821-7.
Kleczyński P, Dziewierz A, Daniec M, et al. Impact of post-dilatation on the reduction of paravalvular leak and mortality after transcatheter aortic valve implantation. Kardiol Pol 2017; 75: 742-8.
John D, Buellesfeld L, Yuecel S, et al. Correlation of device landing zone calcification and acute procedural success in patients undergoing transcatheter aortic valve implantations with the self-expanding CoreValve prosthesis. JACC Cardiovasc Interv 2010; 3: 233-43.
Harbaoui B, Montoy M, Charles P, et al. Aorta calcification burden: towards an integrative predictor of cardiac outcome after transcatheter aortic valve implantation. Atherosclerosis 2016; 246: 161-8.
Koos R, Mahnken AH, Dohmen G, et al. Association of aortic valve calcification severity with the degree of aortic regurgitation after transcatheter aortic valve implantation. Int J Cardiol 2011; 150: 142-5.
Kosek M, Witkowski A, Dąbrowski M, et al. Transcatheter aortic valve implantation in patients with bicuspid aortic valve: a series of cases. Kardiol Pol 2015; 73: 627-36.
Kochman J, Huczek Z, Scisło P, et al. Comparison of one- and 12-month outcomes of transcatheter aortic valve replacement in patients with severely stenotic bicuspid versus tricuspid aortic valves (results from a multicenter registry). Am J Cardiol 2014; 114: 757-62.
Kappetein AP, Head SJ, Généreux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. Am J Cardiol 2012; 60: 1438-54.
Stokłosa P, Szymański P, Dąbrowski M, et al. The impact of transcatheter aortic valve implantation on left ventricular performance and wall thickness – single-centre experience. Postep Kardiol Interv 2015; 11: 37-43.
Unbehaun A, Pasic M, Dreysse S, et al. Transapical aortic valve implantation: incidence and predictors of paravalvular leakage and transvalvular regurgitation in a series of 358 patients. J Am Coll Cardiol 2012; 59: 211-21.
Haensig M, Lehmkuhl L, Rastan AJ, et al. Aortic valve calcium scoring is a predictor of significant paravalvular aortic insufficiency in transapical-aortic valve implantation. Eur J Cardiothorac Surg 2012; 41: 1234- 41.
Ewe SH, Ng AC, Schuijf JD, et al. Location and severity of aortic valve calcium and implications for aortic regurgitation after transcatheter aortic valve implantation. Am J Cardiol 2011; 108: 1470-7.
Schultz CJ, Tzikas A, Moelker A, et al. Correlates on MSCT of paravalvular aortic regurgitation after transcatheter aortic valve implantation using the Medtronic CoreValve prosthesis. JACC Cardiovasc Interv 2011; 78: 446-55.
Vahanian A, Alfieri O, Al-Attar N, et al. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2008; 29: 1463-70.
Khalique OK, Hahn R, Gada H, et al. Quantity and location of aortic valve complex calcification predicts severity and location of paravalvular regurgitation and frequency of post-dilation after balloon-expandable transcatheter aortic valve replacement. JACC Cardiovasc Interv 2014; 7: 885-94.
Wood DA, Tops LF, Mayo JR, et al. Role of multislice computed tomography in transcatheter aortic valve replacement. Am J Cardiol 2009; 103: 1295-301.
Forrest JK. 30-day safety and echocardiographic outcomes following transcatheter aortic valve replacement with the self-expanding repositionable Evolut PRO system. Washington: American College of Cardiology Annual Scientific Session; 2017; 17-9.
Quick links
© 2018 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe