Does Aortic Valve Calcium Score Still Predict Death, Cardiovascular Outcomes, and Conductive Disturbances after Transcatheter Aortic Valve Replacement with New-Generation Prostheses?

Alexandre Gamet; Adeline Chatelin; Jean Mergy; Pauline Bécat; Pierre Roumegou; Luc Christiaens

doi:10.4103/jcecho.jcecho_9_20

Does Aortic Valve Calcium Score Still Predict Death, Cardiovascular Outcomes, and Conductive Disturbances after Transcatheter Aortic Valve Replacement with New-Generation Prostheses?

J Cardiovasc Echogr. 2020 Apr-Jun;30(2):88-92. doi: 10.4103/jcecho.jcecho_9_20. Epub 2020 Aug 17.

Authors

Alexandre Gamet¹, Adeline Chatelin¹, Jean Mergy¹, Pauline Bécat¹, Pierre Roumegou¹, Luc Christiaens¹

Affiliation

¹ Department of Cardiology, Centre Régional Cardio-Vasculaire, CHU De Poitiers, Poitiers, France.

Abstract

Background: The development of transcatheter aortic valve replacement (TAVR) has led to an improvement in morbidity-mortality in the treatment of severe aortic stenosis in patients at high surgical risk. However, the procedure is not free from life-threatening cardiovascular outcomes and conductive disturbances. The objective of our study was to analyze the prognostic impact of aortic valve calcium score on the occurrence of complications following the procedure.

Materials and methods: Patients who have benefited from TAVR with the implantation of new-generation Sapien 3 and Evolut R aortic valve prostheses between January 2017 and July 2018 with the prior realization of a cardiac computed tomography with measurement of the aortic valve calcium score were retrospectively analyzed. Primary endpoint was a composite of death, stroke, and myocardial infarction within a period of 1 month after TAVR. Relation between valvular calcium and conductive disturbances was secondarily analyzed over the same period, and occurrences of high-degree atrioventricular block (paroxysmal or permanent), new-onset left bundle branch block, and the need for permanent or transient cardiac stimulation were associated with the secondary endpoint.

Results: Overall, 144 patients were included. The aortic valve calcium score was not significantly higher in patients who reached the primary endpoint (2936 ± 1235 vs. 3051 ± 1440, P = 0.93). Among the 106 patients analyzed after excluding subjects with a prior pacemaker or left bundle branch block, aortic valvular calcium score was not statistically associated with the occurrence of conduction disturbances (3210 ± 1436 vs. 2948 ± 1223, P = 0.31).

Conclusion: Our results suggest that the measurement of aortic valve calcium score has no prognostic value regarding mortality, cardiovascular events, or conductive disturbances after TAVR using the new generation of valves.

Keywords: Aortic stenosis; aortic valve calcium score; cardiac computed tomography; transcatheter aortic valve replacement.