Paravalvular leak after transcatheter aortic valve implantation: is it anatomically predictable or procedurally
A A Sakrana1, M M Nasr2, G A Ashamallah2
1Madina Cardiac Center, 23411, AL Madinah Al Munawwrah, Khaled Bin Al Waleed Road, Saudi Arabia; Department of Diagnostic and Interventional Radiology, Mansoura University Hospital, 35112, 12 El-Gomhoreya Street, Mansoura, Egypt.
Clinical Radiology
|September 11, 2016
Summary
The transcatheter heart valve (THV) to annulus sizing ratio is a key factor in determining paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI). Anatomical measurements of the aortic root and valve calcification do not predict PVL after TAVI.
Area of Science:
- Cardiovascular Imaging and Intervention
- Structural Heart Disease
- Transcatheter Aortic Valve Replacement
Background:
- Severe symptomatic aortic stenosis necessitates intervention, with transcatheter aortic valve implantation (TAVI) being a primary treatment option.
- Paravalvular leak (PVL) is a known complication following TAVI, potentially impacting clinical outcomes.
- Identifying predictors of PVL is crucial for optimizing TAVI procedures and patient selection.
Purpose of the Study:
- To investigate the determinants of paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI).
- To assess the role of multidetector computed tomography (MDCT) derived aortic root anatomy and aortic valve calcification (AVC) in predicting PVL.
- To evaluate the association between the device-annulus sizing ratio and PVL occurrence and severity.
Main Methods:
- One hundred and eight patients with severe symptomatic aortic stenosis underwent contrast-enhanced ECG-gated MDCT prior to TAVI.
- MDCT was used to measure various aortic root and left ventricular outflow tract (LVOT) parameters, including diameters, perimeter, ellipticity, area, and LVOT-ascending aorta angle.
- Aortic valve calcification (AVC) was graded, and post-TAVI PVL was assessed using transthoracic echocardiography (TTE). The transcatheter heart valve (THV)/annulus sizing ratio was calculated.
Main Results:
- Paravalvular leak (PVL) was observed in 55.56% of patients, with 25% experiencing grade II or higher PVL.
- No significant association was found between PVL and AVC extent/distribution, aortic annulus dimensions, ellipticity index, annulus/LVOT perimeter difference ratio, or LVOT-ascending aorta angle.
- A larger THV/annulus sizing ratio was significantly associated with a lower incidence and degree of PVL (p<0.001).
Conclusions:
- The procedure-related THV/annulus sizing ratio is a significant determinant of PVL severity after TAVI.
- MDCT-derived anatomical measurements of the aortic root and AVC are not reliable predictors of PVL.
- Optimizing the THV/annulus sizing ratio may be key to reducing PVL after TAVI.
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