Computed tomography derived predictors of left ventricular obstruction after TAVR

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Cardiology

Background:

• Left ventricular obstruction (LVO) is a rare but serious complication after transcatheter aortic valve replacement (TAVR), potentially causing hemodynamic instability.
• Limited understanding exists regarding the anatomical predictors of LVO in patients undergoing TAVR, particularly those identifiable via pre-procedural computed tomography (CT).

Purpose of the Study:

• To identify pre-procedural anatomical characteristics using CT scans that predict the risk of developing LVO post-TAVR.
• To elucidate the relationship between specific cardiac dimensions and the occurrence of LVO following TAVR.

Main Methods:

• Retrospective analysis of 349 patients who underwent TAVR between January 2020 and December 2021 at a single center.
• Inclusion criteria: patients with aortic valve stenosis and available pre-procedural CT data; exclusion criteria: prior heart valve surgery.
• CT imaging data were analyzed to assess various anatomical parameters, comparing patients who developed LVO with those who did not.

Main Results:

• 16.3% of patients (57/349) developed post-TAVR LVO.
• Patients with LVO were older, more frequently female, and had smaller body surface area and weight.
• CT analysis revealed a more acute aorto-mitral angle, shorter interventricular septum to leaflet coaptation distance (SLCL), smaller end-systolic left ventricular (LV) areas, and smaller LV outflow tract (LVOT) areas in patients with LVO.
• Multivariate regression identified end-systolic LV area and SLCL as significant predictors of LVO.

Conclusions:

• This study is the first to identify pre-procedural CT imaging predictors for LVO risk following TAVR.
• End-systolic LV area and the anatomical distance between the interventricular septum and leaflet coaptation are significant predictors.
• Further multicenter studies with systematic follow-up are necessary to validate these findings.