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Comparison of outcomes using balloon-expandable versus self-expanding transcatheter prostheses according to the extent of aortic valve calcification

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Abstract

Background

Device landing zone (DLZ) calcification is an important determinant of procedural success in transcatheter aortic valve implantation (TAVI).

Objective

To evaluate the impact of DLZ calcification on procedural outcome with different types of transcatheter heart valves (THVs).

Methods

Aortic valve calcium density (AVCdens) was determined by non-contrast-enhanced computed tomography in 1232 patients undergoing transfemoral TAVI. We stratified the outcome data according to the extent of AVCdens (mild, moderate, severe) and compared balloon-expandable (BE) with self-expanding (SE) THV. Moreover, THVs were subdivided according to their radial force (BE: high; SEmod: moderate; SElow: low).

Results

With BE THV, PVR ≥2° (2.1 vs. 7.9%; p < 0.001), post-dilatation (12.3 vs. 36.6%; p < 0.001), malpositioning (8.4 vs. 13.0%; p = 0.01), device embolization (0.4 vs. 2.6%; p = 0.004), and the need for a second valve (1.2 vs. 3.6%; p = 0.01) were less frequent than with SE devices, but mean transaortic gradients at discharge were higher [12.0 mmHg (8.0–15.0) vs. 9.0 mmHg (6.0–11.0); p < 0.001], and aortic root injury was more frequent (2.7 vs. 0.8%; p = 0.01). In cases of severe calcification, differences between BE and SE THV regarding PVR, post-dilatation, and hemodynamics were mostly pronounced, followed by patients with moderate AVCdens. In cases with low AVCdens, the best outcomes with respect to PVR, pacemaker implantation, and hemodynamics were achieved with SElow THV.

Conclusions

In severe and moderate DLZ calcification, BE devices may have advantages, whereas in mild DLZ calcification, SElow THV showed the most favorable profile.

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Acknowledgements

We thank Elizabeth Martinson, PhD, from the KHFI Editorial Office for her editorial assistance.

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    Authors and Affiliations

    1. Department of Cardiology, Kerckhoff Heart Center, 61231, Bad Nauheim, Germany

      Won-Keun Kim, Christoph Liebetrau, Andreas Rolf & Christian W. Hamm

    2. Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany

      Won-Keun Kim, Arnaud Van Linden, Mani Arsalan, Mirko Doss & Thomas Walther

    3. Institute of Clinical Epidemiology and Biostatistics, University of Amsterdam, Amsterdam, The Netherlands

      Jan G. P. Tijssen

    4. Department of Cardiology and Angiology, Justus-Liebig University of Giessen, Giessen, Germany

      Won-Keun Kim, Christoph Liebetrau, Andreas Rolf & Christian W. Hamm

    5. Department of Internal Medicine and Cardiology, St. Johannes Hospital, Dortmund, Germany

      Johannes Blumenstein, Luise Gaede & Helge Möllmann

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    Correspondence to Won-Keun Kim.

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    WK and HM are proctors for Symetis SA and St. Jude Medical. All other authors declare that they have no financial disclosure relevant to the content of this manuscript.

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    Won-Keun Kim and Johannes Blumenstein contributed equally to this work.

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    Kim, WK., Blumenstein, J., Liebetrau, C. et al. Comparison of outcomes using balloon-expandable versus self-expanding transcatheter prostheses according to the extent of aortic valve calcification. Clin Res Cardiol 106, 995–1004 (2017). https://doi.org/10.1007/s00392-017-1149-3

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