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

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.