Sinus of Valsalva Dimension and Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation

Abstract

Abstract Background Progressive dilatation of the aortic root is a common finding in patients with aortic stenosis. Although ascending aortic root anatomy is routinely evaluated on pre-procedural multi-detector computed tomography (MDCT), its clinical significance has not been adequately studied. Purpose We aimed to investigate the impact of the sinus of Valsalva (SOV) dimension on clinical outcomes in patients undergoing transcatheter aortic valve implantation (TAVI). Methods In a prospective TAVI registry, we retrospectively assessed SOV dimensions by pre-procedural MDCT. Patients were stratified according to tertiles of SOV diameter index to body surface area (SOVi). The primary endpoint was all-cause mortality at 1 year. Results Among 2066 consecutive patients undergoing TAVI between August 2007 and June 2018, 1554 patients were eligible for the present analysis. Patients in the large SOVi group were older (83±6 vs. 82±6 vs. 81±6; p<0.001) and had a higher Society of Thoracic Surgeons Predicted Risk of Mortality (6.3±3.8 vs. 5.1±3.1 vs. 4.9±3.5; p<0.001) than those in the other groups. Patients in the large SOVi group had a higher incidence of moderate or severe paravalvular regurgitation (11.9% vs. 4.5% vs. 3.5%; P<0.001). At 1 year, a large SOVi was independently associated with an increased risk of mortality (HR: 1.64; 95% CI: 1.21–2.23; P=0.001) and major or life-threatening bleeding (HR: 1.30; 95% CI: 1.03–1.65; P=0.029) after TAVI. Conclusions Dilatation of the aortic root at the SOV was associated with adverse outcomes after TAVI. The assessment of the aortic root should be integrated into the risk stratification system in AS patients undergoing TAVI. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2