Dual-parameter risk stratification based on device landing zone calcification and aortic annular perimeter for...

The study aimed to identify independent predictors associated with paravalvular regurgitation (PVR) after self-expanding transcatheter aortic valve replacement (SE-TAVR) and to develop a dual-parameter risk stratification model.

This retrospective study enrolled 292 severe aortic stenosis patients underwent SE-TAVR. PVR severity was assessed pre-discharge. Multivariate logistic regression identified independent predictors of mild/moderate PVR, optimal cutoff values for significant anatomical parameters were determined using receiver operating characteristic (ROC) curve analysis. Patients were subsequently stratified into three risk groups based on these thresholds.

Mild/moderate PVR occurred in 24.0 % of patients. Independent predictors included aortic annular perimeter (OR:1.067, P = 0.015), device landing zone calcific volume (OR:1.006 per 10 mm³, P = 0.025), and presence of sealing skirt (OR:0.412, P = 0.010). The combination of these predictors had a higher discriminative performance (AUC=0.779) than single predictors (P = 0.036, 0.007, and <0.001, respectively), with significant integrated discrimination improvement (integrated discrimination improvement=5.4-6.7 %, P < 0.001). ROC-derived thresholds (device landing zone calcific volume≥1240 mm³ and aortic annular perimeter≥77 mm) stratified patients into three risk groups with progressively increasing PVR incidence: Group A (neither elevate):8.4 %; Group B (either elevated):23.7 %; and Group C (both elevated):48.7 %. Pairwise comparisons confirming differences between Group A vs. B (P = 0.003) and Group B vs. C (P < 0.001). Sealing skirts significantly reduced PVR in Groups A (P = 0.042) but not in Group B and C (P = 0.082 and 0.342).

The dual-parameter model based on device landing zone calcification and aortic annular perimeter significantly enhances PVR risk stratification after SE-TAVR. The dual-threshold model provides a clinically actionable tool for pre-procedural risk stratification and personalized valve selection.