Impact of Aortic Valve Calcium Burden on Paravalvular Leak Across Balloon-Expandable and Self-Expanding Valves: Insights from a Large TAVR Cohort

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Abstract
Background: Aortic valve calcium score (AVCS) is associated with an increased risk of paravalvular leak (PVL) after Transcatheter aortic valve replacement (TAVR). We aimed to evaluate the association between AVCS burden and procedural outcomes, particularly PVL, and to determine whether valve platform performance differs according to calcium burden. Methods: This study included patients with severe aortic stenosis undergoing TAVR with balloon-expandable (Sapien platform) or self-expanding (Evolut and Navitor platforms) valves. The primary endpoint was the rate of any and moderate or greater PVLs according to AVCS burden (p = 0.010), as did moderate or greater PVLs (5% vs. 3%; p = 0.011). In multivariable analysis, both SEV implantation and AVCS ≥ 3000 AU were independent predictors of moderate or greater PVL, while the interaction between AVCS burden and valve platform was not significant. When restricted to contemporary-generation valves, PVL rates were lower overall but remained higher in patients with an AVCS ≥ 3000 AU (4.4% vs. 2.4%; p = 0.001), with smaller differences between valve platforms. Conclusions: A higher AVCS is associated with increased PVLs after TAVR. BEVs showed lower rates of moderate or greater PVLs than SEVs, although no statistically significant interaction between AVCS burden and valve platform was observed. With contemporary-generation valves, overall PVL rates were reduced, and platform differences were attenuated.

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