Transcatheter Aortic Valve Explants: Calcification Patterns and Leaflet Thickening to Inform Repeat Interventions

David Meier; Joshua Yoon; Cole Glenna; Anish Nigade; Althea Lai; Noah Tregobov; Shahnaz Javani; Hacina Gill; Julianne Spencer; Brooke MacLeod; Georg Lutter; Thomas Puehler; Gilbert H.L. Tang; John G. Webb; David A. Wood; Toby Rogers; Shinichi Fukuhara; Stephanie Sellers

doi:10.1016/j.cjca.2026.03.032

Transcatheter Aortic Valve Explants: Calcification Patterns and Leaflet Thickening to Inform Repeat Interventions

David Meier
, Joshua Yoon
, Cole Glenna
, Anish Nigade
, Althea Lai
, Noah Tregobov
, Shahnaz Javani
, Hacina Gill
, Julianne Spencer
, Brooke MacLeod
, Georg Lutter
, Thomas Puehler
, Gilbert H.L. Tang
, John G. Webb
, David A. Wood
, Toby Rogers
, Shinichi Fukuhara
, Stephanie Sellers

Research output: Contribution to journal › Article › peer-review

Abstract

Background Degeneration is an inevitable outcome for bioprosthetic heart valves. In the setting of transcatheter aortic valve (TAV) replacement (TAVR), calcifications and leaflet thickening have implications for feasibility and outcomes of repeat interventions, including leaflet modification techniques. In this study, we aimed to investigate the frequency and pattern of leaflet calcification and thickening in explanted TAVs to inform repeat interventions. Methods TAV explants were obtained from the Explanted THV registry and clinical institutions. Micro-computed tomography imaging and histology were used to evaluated TAV calcium volume, distribution, and leaflet thickening. Results Twenty TAV explants were analyzed: 11 self-expanding CoreValve/Evolut (Medtronic, Dublin, Ireland) TAVs, 8 balloon-expandable Sapien 3 (Edwards Lifesciences, Irvine, CA) TAVs, and 1 mechanically-expandable Lotus (Boston Scientific, Marlborough, MA) TAV. Median patient age at explant was 73.0 (interquartile range [IQR], 63.0-81.0) years, with a median time to explant of 3 years and 3 months (IQR, 1 year and 10 months to 4 years and 10 months). Eleven TAVs (55%) had leaflet calcification (median, 77.9; IQR, 24.7-336.1) mm³, and 9 TAVs (45%) had no calcium according to micro-computed tomography. Calcified TAVs had an increased leaflet thickness compared with noncalcific samples (median, 1.02 [IQR, 0.81-1.59] mm vs 0.64 [IQR, 0.47-0.89 mm]; P = 0.006). Leaflet thickness had a positive correlation with implant duration. Calcium distribution was heterogenous within each individual leaflet but also among leaflets of an individual TAV. Calcium pattern appeared to differ between TAV models. Conclusions Calcified TAVs tend to have thicker leaflets and calcium distribution appears to vary according to TAV type. These findings might have important clinical implications when considering redo-TAV replacement and leaflet modification techniques.

Original language	English
Journal	Canadian Journal of Cardiology
DOIs	https://doi.org/10.1016/j.cjca.2026.03.032
State	Accepted/In press - 2026
Externally published	Yes

Keywords

Transcatheter aortic valve replacement
calcification
degeneration
histopathology
redo transcatheter aortic valve replacement

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10.1016/j.cjca.2026.03.032

Cite this

Meier, D., Yoon, J., Glenna, C., Nigade, A., Lai, A., Tregobov, N., Javani, S., Gill, H., Spencer, J., MacLeod, B., Lutter, G., Puehler, T., Tang, G. H. L., Webb, J. G., Wood, D. A., Rogers, T., Fukuhara, S., & Sellers, S. (Accepted/In press). Transcatheter Aortic Valve Explants: Calcification Patterns and Leaflet Thickening to Inform Repeat Interventions. Canadian Journal of Cardiology. https://doi.org/10.1016/j.cjca.2026.03.032

@article{1fd01c948efc40c183c5d90d310e3da6,

title = "Transcatheter Aortic Valve Explants: Calcification Patterns and Leaflet Thickening to Inform Repeat Interventions",

abstract = "Background Degeneration is an inevitable outcome for bioprosthetic heart valves. In the setting of transcatheter aortic valve (TAV) replacement (TAVR), calcifications and leaflet thickening have implications for feasibility and outcomes of repeat interventions, including leaflet modification techniques. In this study, we aimed to investigate the frequency and pattern of leaflet calcification and thickening in explanted TAVs to inform repeat interventions. Methods TAV explants were obtained from the Explanted THV registry and clinical institutions. Micro-computed tomography imaging and histology were used to evaluated TAV calcium volume, distribution, and leaflet thickening. Results Twenty TAV explants were analyzed: 11 self-expanding CoreValve/Evolut (Medtronic, Dublin, Ireland) TAVs, 8 balloon-expandable Sapien 3 (Edwards Lifesciences, Irvine, CA) TAVs, and 1 mechanically-expandable Lotus (Boston Scientific, Marlborough, MA) TAV. Median patient age at explant was 73.0 (interquartile range [IQR], 63.0-81.0) years, with a median time to explant of 3 years and 3 months (IQR, 1 year and 10 months to 4 years and 10 months). Eleven TAVs (55\%) had leaflet calcification (median, 77.9; IQR, 24.7-336.1) mm3, and 9 TAVs (45\%) had no calcium according to micro-computed tomography. Calcified TAVs had an increased leaflet thickness compared with noncalcific samples (median, 1.02 [IQR, 0.81-1.59] mm vs 0.64 [IQR, 0.47-0.89 mm]; P = 0.006). Leaflet thickness had a positive correlation with implant duration. Calcium distribution was heterogenous within each individual leaflet but also among leaflets of an individual TAV. Calcium pattern appeared to differ between TAV models. Conclusions Calcified TAVs tend to have thicker leaflets and calcium distribution appears to vary according to TAV type. These findings might have important clinical implications when considering redo-TAV replacement and leaflet modification techniques.",

keywords = "Transcatheter aortic valve replacement, calcification, degeneration, histopathology, redo transcatheter aortic valve replacement",

author = "David Meier and Joshua Yoon and Cole Glenna and Anish Nigade and Althea Lai and Noah Tregobov and Shahnaz Javani and Hacina Gill and Julianne Spencer and Brooke MacLeod and Georg Lutter and Thomas Puehler and Tang, \{Gilbert H.L.\} and Webb, \{John G.\} and Wood, \{David A.\} and Toby Rogers and Shinichi Fukuhara and Stephanie Sellers",

note = "Publisher Copyright: {\textcopyright} 2026 The Authors.",

year = "2026",

doi = "10.1016/j.cjca.2026.03.032",

language = "English",

journal = "Canadian Journal of Cardiology",

issn = "0828-282X",

publisher = "Elsevier Inc.",

}

Meier, D, Yoon, J, Glenna, C, Nigade, A, Lai, A, Tregobov, N, Javani, S, Gill, H, Spencer, J, MacLeod, B, Lutter, G, Puehler, T, Tang, GHL, Webb, JG, Wood, DA, Rogers, T, Fukuhara, S & Sellers, S 2026, 'Transcatheter Aortic Valve Explants: Calcification Patterns and Leaflet Thickening to Inform Repeat Interventions', Canadian Journal of Cardiology. https://doi.org/10.1016/j.cjca.2026.03.032

TY - JOUR

T1 - Transcatheter Aortic Valve Explants

T2 - Calcification Patterns and Leaflet Thickening to Inform Repeat Interventions

AU - Meier, David

AU - Yoon, Joshua

AU - Glenna, Cole

AU - Nigade, Anish

AU - Lai, Althea

AU - Tregobov, Noah

AU - Javani, Shahnaz

AU - Gill, Hacina

AU - Spencer, Julianne

AU - MacLeod, Brooke

AU - Lutter, Georg

AU - Puehler, Thomas

AU - Tang, Gilbert H.L.

AU - Webb, John G.

AU - Wood, David A.

AU - Rogers, Toby

AU - Fukuhara, Shinichi

AU - Sellers, Stephanie

PY - 2026

Y1 - 2026

N2 - Background Degeneration is an inevitable outcome for bioprosthetic heart valves. In the setting of transcatheter aortic valve (TAV) replacement (TAVR), calcifications and leaflet thickening have implications for feasibility and outcomes of repeat interventions, including leaflet modification techniques. In this study, we aimed to investigate the frequency and pattern of leaflet calcification and thickening in explanted TAVs to inform repeat interventions. Methods TAV explants were obtained from the Explanted THV registry and clinical institutions. Micro-computed tomography imaging and histology were used to evaluated TAV calcium volume, distribution, and leaflet thickening. Results Twenty TAV explants were analyzed: 11 self-expanding CoreValve/Evolut (Medtronic, Dublin, Ireland) TAVs, 8 balloon-expandable Sapien 3 (Edwards Lifesciences, Irvine, CA) TAVs, and 1 mechanically-expandable Lotus (Boston Scientific, Marlborough, MA) TAV. Median patient age at explant was 73.0 (interquartile range [IQR], 63.0-81.0) years, with a median time to explant of 3 years and 3 months (IQR, 1 year and 10 months to 4 years and 10 months). Eleven TAVs (55%) had leaflet calcification (median, 77.9; IQR, 24.7-336.1) mm3, and 9 TAVs (45%) had no calcium according to micro-computed tomography. Calcified TAVs had an increased leaflet thickness compared with noncalcific samples (median, 1.02 [IQR, 0.81-1.59] mm vs 0.64 [IQR, 0.47-0.89 mm]; P = 0.006). Leaflet thickness had a positive correlation with implant duration. Calcium distribution was heterogenous within each individual leaflet but also among leaflets of an individual TAV. Calcium pattern appeared to differ between TAV models. Conclusions Calcified TAVs tend to have thicker leaflets and calcium distribution appears to vary according to TAV type. These findings might have important clinical implications when considering redo-TAV replacement and leaflet modification techniques.

AB - Background Degeneration is an inevitable outcome for bioprosthetic heart valves. In the setting of transcatheter aortic valve (TAV) replacement (TAVR), calcifications and leaflet thickening have implications for feasibility and outcomes of repeat interventions, including leaflet modification techniques. In this study, we aimed to investigate the frequency and pattern of leaflet calcification and thickening in explanted TAVs to inform repeat interventions. Methods TAV explants were obtained from the Explanted THV registry and clinical institutions. Micro-computed tomography imaging and histology were used to evaluated TAV calcium volume, distribution, and leaflet thickening. Results Twenty TAV explants were analyzed: 11 self-expanding CoreValve/Evolut (Medtronic, Dublin, Ireland) TAVs, 8 balloon-expandable Sapien 3 (Edwards Lifesciences, Irvine, CA) TAVs, and 1 mechanically-expandable Lotus (Boston Scientific, Marlborough, MA) TAV. Median patient age at explant was 73.0 (interquartile range [IQR], 63.0-81.0) years, with a median time to explant of 3 years and 3 months (IQR, 1 year and 10 months to 4 years and 10 months). Eleven TAVs (55%) had leaflet calcification (median, 77.9; IQR, 24.7-336.1) mm3, and 9 TAVs (45%) had no calcium according to micro-computed tomography. Calcified TAVs had an increased leaflet thickness compared with noncalcific samples (median, 1.02 [IQR, 0.81-1.59] mm vs 0.64 [IQR, 0.47-0.89 mm]; P = 0.006). Leaflet thickness had a positive correlation with implant duration. Calcium distribution was heterogenous within each individual leaflet but also among leaflets of an individual TAV. Calcium pattern appeared to differ between TAV models. Conclusions Calcified TAVs tend to have thicker leaflets and calcium distribution appears to vary according to TAV type. These findings might have important clinical implications when considering redo-TAV replacement and leaflet modification techniques.

KW - Transcatheter aortic valve replacement

KW - calcification

KW - degeneration

KW - histopathology

KW - redo transcatheter aortic valve replacement

UR - https://www.scopus.com/pages/publications/105035714890

U2 - 10.1016/j.cjca.2026.03.032

DO - 10.1016/j.cjca.2026.03.032

M3 - Article

C2 - 41887366

AN - SCOPUS:105035714890

SN - 0828-282X

JO - Canadian Journal of Cardiology

JF - Canadian Journal of Cardiology

ER -

Transcatheter Aortic Valve Explants: Calcification Patterns and Leaflet Thickening to Inform Repeat Interventions

Abstract

Keywords

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