Prediction of paravalvular leakage after transcatheter aortic valve implantation.

Luigi F M Di Martino,Carl Schultz,Nicolas M Van Mieghem,Wim B Vletter,Osama I I Soliman,Ben Ren,Peter P De Jaegere,Marcel L Geleijnse,Matteo Di Biase

doi:10.1007/s10554-015-0703-1

Abstract

Significant paravalvular leakage (PVL) after transcatheter aortic valve implantation (TAVI) is related to patient mortality. Predicting the development of PVL has focused on computed tomography (CT) derived variables but literature targeting CoreValve devices is limited, controversial, and did not make use of standardized echocardiographic methods. The study included 164 consecutive patients with severe aortic stenosis that underwent TAVI with a Medtronic CoreValve system©, with available pre-TAVI CT and pre-discharge transthoracic echocardiography. The predictive value for significant PVL of the CT-derived Agatston score, aortic annulus size and eccentricity, and “cover index” was assessed, according to both echocardiographic Valve Academic Research Consortium (VARC) criteria and angiographic Sellers criteria. Univariate predictors for more than mild PVL were the maximal diameter of the aortic annulus size (for both angiographic and echocardiographic assessment of PVL), cover index (for echocardiographic assessment of PVL only), and Agatston score (for both angiographic and echocardiographic assessment of PVL). The aortic annulus eccentricity index was not predicting PVL. At multivariate analysis, Agatston score was the only independent predictor for both angiographic and echocardiographic assessment of PVL. Agatston score is the only independent predictor of PVL regardless of the used imaging technique for the definition of PVL.

Highlights

Paravalvular aortic leakage (PVL) after transcatheter aortic valve implantation (TAVI) is a complication with potentially severe consequences [1,2,3,4,5,6]
Predicting the development of paravalvular leakage (PVL) has focused on computed tomography (CT) derived variables but literature targeting CoreValve devices is limited, controversial, and did not make use of standardized echocardiographic methods
The main focus in predicting the development of PVL has been on computed tomography (CT) derived variables such as calcium quantification with the Agatston score, aortic annulus size and eccentricity, and indexes relating the annulus dimensions to prosthesis size like the ‘‘cover index’’ [3]

Summary

Introduction

Paravalvular aortic leakage (PVL) after transcatheter aortic valve implantation (TAVI) is a complication with potentially severe consequences [1,2,3,4,5,6]. The main focus in predicting the development of PVL has been on computed tomography (CT) derived variables such as calcium quantification with the Agatston score, aortic annulus size and eccentricity, and indexes relating the annulus dimensions to prosthesis size like the ‘‘cover index’’ [3]. Prediction of PVL may be different for the various percutaneous valves, since the CoreValve Revalving SystemÓ is self-expandable while the Edwards SAPIENTM prosthesis is a balloon-expandable one. Agatston score was predictive for PVL in all published CoreValve specific studies [7,8,9]. The value of aortic annulus eccentricity was investigated in only one small study [10] and aortic annulus size or the ‘‘cover index’’ was only analyzed in two relatively small

Methods

Results

Conclusion