Predicting Perivalvular Leak Following Sapien 3 Implantation Using Virtual Valve-Based Computed Tomography Imaging

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Radiology

Background:

• Perivalvular leak (PVL) is a complication following transcatheter aortic valve implantation (TAVI).
• Accurate prediction of PVL is crucial for patient management after Sapien 3 valve implantation.
• Computed tomography (CT) imaging offers potential for pre-procedural risk assessment.

Purpose of the Study:

• To evaluate the predictive capability of quantifying aortic valve calcification using a virtual valve (VV) on CT imaging.
• To determine the association between VV-derived calcium volumes and the incidence of PVL after Sapien 3 TAVI.
• To identify optimal CT-based thresholds for predicting significant PVL.

Main Methods:

• Retrospective analysis of 126 patients who underwent Sapien 3 implantation.
• Exclusion of patients with left ventricular outflow tract calcification or bicuspid valves.
• Measurement of calcium volumes (outside VV, inside VV, entire valve) using multiplanar CT reconstructions and VV.
• Quantitative assessment of PVL using transthoracic echocardiography (%PVL).

Main Results:

• Calcium volumes outside, inside, and across the entire VV were significantly correlated with %PVL.
• Calcium volume outside the VV showed the highest predictive performance (AUC 0.82) for significant PVL (≥10%).
• Optimal cutoff for calcium volume outside the VV was ≥336.9 mm³ (100% sensitivity, 59.3% specificity).

Conclusions:

• Quantifying aortic valve calcification using VV on CT imaging is a valuable tool.
• This CT-based approach accurately predicts significant PVL after Sapien 3 implantation.
• The findings support the use of VV CT analysis for pre-procedural risk stratification in TAVI patients.