Impact of Device Landing Zone Calcification in Transcatheter Aortic Valve Implantation – The Device Landing Zone Calcification Score

Objectives: Aim of study was to assess the influence of the amount of calcifications of the aortic valve and the left ventricular outflow tract (LVOT) on the acute procedural outcome in patients undergoing transcatheter aortic valve implantation (TAVI).

Aims: TAVI is an established procedure for high-risk patients with significant aortic stenosis (AS, 1–3). After TAVI post-interventional paravalvular aortic regurgitation (PAR) can occur, which is believed to be related to calcifications in the device ‘landing zone’ (DLZ, 4). Recently developed aortic valve calcification scores don´t consider the LVOT as part of the DLZ despite the fact that in AS calcification is often not limited to the aortic valve level (5–6).

Methods: We prospectively analyzed 100 symptomatic patients with severe AS scheduled for TAVI using the CoreValve prosthesis. For semi-quantitative assessment of DLZ calcification load contrast-enhanced multi-slice cardiac computed tomography was accomplished pre-interventionally as part of the TAVI screening process. DLZ was defined as the area including the aortic valve and the LVOT. Using multiplanar reconstruction of the aortic root and the LVOT (fig.1), we developed a 4-step scoring system of DLZ calcification (device `landing zone´ calcification score, DLZ-CS, fig.2). Aortography was performed to evaluate the PAR after initial device release (PAR0) and after termination of the procedure (PAR1).

Results: The DLZ calcification score showed a significant correlation with the grade of PAR (PAR0: r=0.356, p<0.001 and PAR1: r=0.240, p=0.016).

Conclusion: DLZ calcification impairs the acute procedural outcome concerning PAR in TAVI. By now, a semi-quantitative calcification scoring system (DLZ-CS) is available in patients undergoing TAVI, which considers the LVOT as an important part of the DLZ. Consecutively, a pre-interventional cardiac CT-imaging including the determination of DLZ calcification is requested to specify the probable device result.

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