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Original research
Impact of device landing zone calcification patterns on paravalvular regurgitation after transcatheter aortic valve replacement with different next-generation devices
  1. Victor Mauri1,
  2. Thomas Frohn1,
  3. Florian Deuschl2,
  4. Kawa Mohemed3,
  5. Kathrin Kuhr1,
  6. Andreas Reimann1,
  7. Maria Isabel Körber1,
  8. Niklas Schofer2,
  9. Matti Adam1,
  10. Kai Friedrichs3,
  11. Elmar W Kuhn1,
  12. Smita Scholtz3,
  13. Volker Rudolph3,
  14. Thorsten C W Wahlers4,
  15. Stephan Baldus5,
  16. Navid Mader4,
  17. Ulrich Schäfer2 and
  18. Tanja K Rudolph3
  1. 1Heart Center, University of Cologne, Koln, Germany
  2. 2Departement of Cardiology, University Hospital Hamburg Eppendorf University Heart Centre, Hamburg, Hamburg, Germany
  3. 3General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
  4. 4Department of Cardiothoracic Surgery, Klinikum der Universität zu Köln, Klinik und Poliklinik für Herz- und Thoraxchirurgie, Cologne, Germany
  5. 5Department of Internal Medicine III, University of Cologne, Cologne, Germany
  1. Correspondence to Professor Tanja K Rudolph; trudolph{at}


Objective Residual paravalvular regurgitation (PVR) has been associated to adverse outcomes after transcatheter aortic valve replacement (TAVR). This study sought to evaluate the impact of device landing zone (DLZ) calcification on residual PVR after TAVR with different next-generation transcatheter heart valves.

Methods 642 patients underwent TAVR with a SAPIEN 3 (S3; n=292), ACURATE neo (NEO; n=166), Evolut R (ER; n=132) or Lotus (n=52). Extent, location and asymmetry of DLZ calcification were assessed from contrast-enhanced CT imaging and correlated to PVR at discharge.

Results PVR was ≥moderate in 0.7% of S3 patients, 9.6% of NEO patients, 9.8% of ER patients and 0% of Lotus patients (p<0.001), and these differences remained after matching for total DLZ calcium volume. The amount of DLZ calcium was significantly related to the degree of PVR in patients treated with S3 (p=0.045), NEO (p=0.004) and ER (p<0.001), but not in Lotus patients (p=0.698). The incidence of PVR ≥moderate increased significantly over the tertiles of DLZ calcium volume (p=0.046). On multivariable analysis, calcification of the aortic valve cusps, LVOT calcification and the use of self-expanding transcatheter aortic valve implantation (TAVI) prostheses emerged as predictors of PVR.

Conclusions The susceptibility to PVR depending on the amount of calcium was mainly observed in self-expanding TAVI prostheses. Thus, DLZ calcification is an important factor to be considered in prosthesis selection for each individual patient, keeping in mind the trade-off between PVR reduction, risk of new pacemaker implantation and unfavourable valve ha emodynamics.

  • prosthetic heart valves
  • aortic valve disease
  • calcium

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  • Contributors VM and TR designed the study. TF, FD, KM, AR, NS, MA and SS performed CT analysis. VM, FD, KM, MIK, KF and NS performed TTE analysis. VM, TF, FD, KM, AR, MIK, NS, MA, KF, EWK and SS contributed to clinical patient data acquisition. VM and KK performed the statistical analyses. VM, VR and TR interpreted the data. VM and TR wrote the main manuscript text. EWK, VR, TCWW, SB, NM and US contributed to important intellectual content and critically revised the manuscript. TR supervised the work. All authors read and approved the final manuscript.

    We acknowledge support by the DFG Open Access Publication Funds of the Ruhr-Universität Bochum.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests FD received speakers honoraria from Boston Scientific. NS received travel compensation from Edwards and speakers honoraria and travel compensation from Boston Scientific. VR received speakers honoraria from Medtronic. TCWW and NM are proctors for Edwards. SB is a proctor for Edwards and received a research grant from Edwards. US is proctor for Edwards and Symetis SA and received research grants from Symetis SA and Edwards. TR is proctor for Boston Scientific and and received speakers honoraria from Edwards, Medtronic and Boston Scientific/Symetis.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Ethics Committee of the University Hospital of Cologne (ID 19-1032).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available from the first author on reasonable request.

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