Transcatheter Aortic Valve Implantation with the Third Generation Balloon-Expandable Bioprosthesis in Patients with Severe Landing Zone Calcium

ABSTRACT Device success of earlier generation balloon-expandable transcatheter heart valves (BE-THV) is lower in patients with severe landing zone calcium (LZC). We sought to explore the impact of LZC on the outcome of transcatheter aortic valve implantation (TAVI) with the next generation Edwards Sapien 3 BE-THV. In the present study, severe LZC was defined as severe aortic valve cusp calcium (AVC) and/or left ventricular outflow tract calcium (LVOTC) on computed tomography. Patients who underwent TAVI for pure/predominant aortic regurgitation, bicuspid aortic valve disease, or failed bioprosthetic valve were excluded. Out of 350 patients who underwent TAVI with the Edwards Sapien 3 (age: 80.7±6.1, female: 45.1%, STS score: 4.9±3.8, transfemoral: 97.4%), 106 (30.3%) had severe LZC; 78 severe AVC (22.3%) and 49 severe LVOTC (14.0%). Severe LZC was associated with lower device success (96.2% vs. 100%, p=0.008) driven by more prosthetic valve regurgitation (PVR, p=0.008). On multivariable analysis, PVR was associated with severe LVOTC (OR [95% CI]: 2.130 [1.092-4.158]) but not with severe AVC (1.529 [0.835-2.800]). Balloon predilatation (BPreD) was performed in 42.5% of patients with severe LZC (vs. 19.3% in non-severe LZC; p