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

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 (AVC_dens) was determined by non-contrast-enhanced computed tomography in 1232 patients undergoing transfemoral TAVI. We stratified the outcome data according to the extent of AVC_dens (mild, moderate, severe) and compared balloon-expandable (BE) with self-expanding (SE) THV. Moreover, THVs were subdivided according to their radial force (BE: high; SE_mod: moderate; SE_low: 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 AVC_dens. In cases with low AVC_dens, the best outcomes with respect to PVR, pacemaker implantation, and hemodynamics were achieved with SE_low THV.

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

Keywords: Aortic stenosis; Aortic valve calcification; MDCT; TAVI.