Pass the Rock: calcium, the achilles heel of transcatheter valve replacement

Key Points

• Increasing annular calcification portends more adverse outcomes and worse hemodynamic results following percutaneous structural heart interventions.
• Though the Direct Flow prosthesis did not appear to have significantly different post-procedural gradients based on aortic valve calcium burden in a selected group of patients, the average residual gradients were relatively high in all cases and the presence of a paravalvular leak was more common with increasing valvular calcification.
• It is unclear how the Direct Flow prosthesis fits into the armamentarium of TAVR prostheses

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