Calcium Load in the Aortic Valve, Aortic Root, and Left Ventricular Outflow Tract and the Risk for a Periprocedural Stroke

Henrik Bjursten, Sasha Koul, Olov Duvernoy, Erika Fagman, Ninos Samano, Johan Nilsson, Niels Erik Nielsen, Andreas Rück, Jan Johansson, Stefan James, Magnus Settergren, Matthias Götberg, Adrian Pistea

Research output: Contribution to journalArticlepeer-review


Background: Periprocedural stroke during transcatheter aortic valve implantation is a rare but devastating complication. The calcified aortic valve is the most likely source of the emboli in a periprocedural stroke. The total load and distribution of calcium in the leaflets, aortic root, and left ventricular outflow tract varies from patient to patient. Consequently, there could be patterns of calcification that are associated with a higher risk of stroke. This study aimed to explore whether the pattern of calcification in the left ventricular outflow tract, annulus, aortic valve, and ascending aorta can be used to predict a periprocedural stroke. Methods: Among the 3282 consecutive patients who received a transcatheter aortic valve implantation in the native valve in Sweden from 2014 to 2018, we identified 52 who had a periprocedural stroke. From the same cohort, a control group of 52 patients was constructed by propensity score matching. Both groups had one missing cardiac computed tomography, and 51 stroke and 51 control patients were blindly reviewed by an experienced radiologist. Results: The groups were well balanced in terms of demographics and procedural data. Of the 39 metrics created to describe calcium pattern, only one differed between the groups. The length of calcium protruding above the annulus was 10.6 mm (interquartile range 7-13.6) for patients without stroke and 8 mm (interquartile range 3-10) for stroke patients. Conclusions: This study could not find any pattern of calcification that predisposes for a periprocedural stroke.

Original languageEnglish
Article number100070
JournalStructural Heart
Issue number4
Early online date2022
Publication statusPublished - 2022

Subject classification (UKÄ)

  • Cardiac and Cardiovascular Systems
  • Radiology, Nuclear Medicine and Medical Imaging
  • Surgery

Free keywords

  • Cerebral protection device
  • Outcome
  • TAVR
  • Transcatheter aortic valve replacement


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