Aims Paravalvular aortic leakage (PVL) after transcatheter aortic valve implantation (TAVI) is a complication with potentially severe consequences. The relation between native aortic root calcium burden, stent frame eccentricity and PVL was not studied before. Methods and results Two-hundred-and-twenty-three consecutive patients with severe aortic stenosis who underwent TAVI with a Medtronic CoreValve SystemVC and who had available pre-discharge transthoracic echocardiography were studied. Echocardiographic stent inflow frame eccentricity was defined as major-minor diameter in a short-axis view >2 mm. PVL was scored according to the updated Valve Academic Research Consortium (VARC-2) recommendations. In a subgroup of 162 (73%) patients, the calcium Agatston score was available. Stent frame eccentricity was seen in 77 (35%) of patients. The correlation between the Agatston score and stent frame eccentricity was significant (q = 0.241, P = 0.003). Paravalvular leakage was absent in 91 cases (41%), mild in 67 (30%), moderate in 51 (23%), and severe in 14 (6%) cases. The correlation between stent frame eccentricity and PVL severity was significant (q = 0.525, P < 0.0001). There was a relation between particular eccentric stent frame shapes and the site of PVL. Conclusion Calcification of the aortic annulus is associated with a subsequent eccentric shape of the CoreValve prosthesis. This eccentric shape results in more PVL, with the localization of PVL related to the shape of stent frame.

Additional Metadata
Keywords aortic, calcification, eccentricity, echocardiography, regurgitation, stenosis, TAVR, valve
Persistent URL dx.doi.org/10.1093/ehjci/jex009, hdl.handle.net/1765/101921
Journal European Heart Journal Cardiovascular Imaging
Citation
Di Martino, L.F.M, Soliman, O.I.I, van Gils, L, Vletter, W.B, van Mieghem, N.M, Ren, B, … Geleijnse, M.L. (2017). Relation between calciumburden, echocardiographic stent frame eccentricity and paravalvular leakage after corevalve transcatheter aortic valve implantation. European Heart Journal Cardiovascular Imaging, 18(6), 648–653. doi:10.1093/ehjci/jex009