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.

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Keywords aortic, calcification, eccentricity, echocardiography, regurgitation, stenosis, TAVR, valve
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Journal European Heart Journal Cardiovascular Imaging
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