Severe Paravalvular Aortic Regurgitation Research Articles

Transcatheter Aortic Valve Implantation with Corevalve®: A New Mode of Therapy for Surgically High-Risk Patients with Severe or Critical Aortic Stenosis

INTRODUCTION: Aortic Stenosis (AS) is a common and life-threatening disease that presents with angina, heart failure, or syncope. Internationally, transcatheter aortic valve implantation (TAVI) has become accepted as a less invasive percutaneous alternative to surgical replacement for high-risk patients with severe or critical AS. OBJECTIVE: This paper presents the first TAVI case performed at The Heart Institute of the Chinese General Hospital and Medical Center, and reports the first valve-in-valve TAVI case in the Philippines. CASE: An 87-year old diabetic male patient presented with congestive heart failure and a history of coronary artery bypass grafting, chronic obstructive pulmonary disease, and chronic renal insufficiency. A 2-D echocardiogram (2DE) revealed severe AS with normal left ventricular function. Left heart catheterization confirmed severe AS and showed severe triple vessel coronary artery disease with continued patency of all bypass grafts. Surgical aortic valve replacement was recommended but deemed too high-risk. Ancillary studies revealed that the patient was a viable candidate for TAVI. A 29-mm Corevalve® was implanted, with subsequent moderate to severe paravalvular aortic regurgitation (AR). A second 29-mm Corevalve® was implanted within the first Corevalve®. The patient tolerated the procedure well with marked improvement in symptoms. A repeat 2DE showed normal functioning bioprosthetic valve with minimal AR. CONCLUSION: TAVI is an alternative mode of therapy in carefully selected surgically high-risk patients with severe or critical AS. Careful and thorough pre-procedural measurements are key for proper valve sizing. Post TAVI calculation of the aortic regurgitation index is important in determining the short- and long term success of the procedure.

3-Dimensional Aortic Annular Assessment by Multidetector Computed Tomography Predicts Moderate or Severe Paravalvular Regurgitation After Transcatheter Aortic Valve Replacement: A Multicenter Retrospective Analysis

This study sought to analyze multidetector computed tomography (MDCT) 3-dimensional aortic annular dimensions for the prediction of paravalvular aortic regurgitation (PAR) following transcatheter aortic valve replacement (TAVR).Moderate or severe PAR after TAVR is associated with increased morbidity and mortality.A total of 109 consecutive patients underwent MDCT pre-TAVR with a balloon expandable aortic valve. Differences between transcatheter heart valve (THV) size and MDCT measures of annular size (mean diameter, area, and circumference) were analyzed concerning prediction of PAR. Patients with THV malposition (n = 7) were excluded. In 50 patients, MDCT was repeated after TAVR to assess THV eccentricity (1 - short diameter/long diameter) and expansion (MDCT measured THV area/nominal THV area).Moderate or severe PAR (13 of 102) was associated with THV undersizing (THV diameter - mean diameter = -0.7 ± 1.4 mm vs. 0.9 ± 1.8 mm for trivial to mild PAR, p < 0.01). The difference between THV size and MDCT annular size was predictive of PAR (mean diameter: area under the curve [AUC]: 0.81, 95% confidence interval [CI]: 0.68 to 0.88; area: AUC: 0.80, 95% CI: 0.65 to 0.90; circumference: AUC: 0.76, 95% CI: 0.59 to 0.91). Annular eccentricity was not associated with PAR (AUC: 0.58, 95% CI: 0.46 to 0.75). We found that 35.3% (36 of 102) and 45.1% (46 of 102) of THVs were undersized relative to the MDCT mean diameter and area, respectively. THV oversizing relative to the annular area was not associated with THV eccentricity or underexpansion (oversized vs. undersized THVs; expansion: 102.7 ± 5.3% vs. 106.1 ± 5.6%, p = 0.03; eccentricity: median: 1.7% [interquartile range: 1.4% to 3.0%] vs. 1.7% [interquartile range: 1.1% to 2.7%], p = 0.28).MDCT-derived 3-dimensional aortic annular measurements are predictive of moderate or severe PAR following TAVR. Oversizing of THVs may reduce the risk of moderate or severe PAR.

96/00149 Oil, environment and technology

The impact of paravalvular aortic regurgitation (PAR) on hemodynamic performance after transcatheter aortic valve implantation (TAVI) remains disputable. Common parameters such as the diastolic blood pressure or the blood pressure amplitude do not provide reproducible results. The aim of our study was to evaluate the impact of PAR on hemodynamics and outcome using the relative amplitude index (RAI).PAR was prospectively evaluated by echocardiography before discharge in 110 patients. The RAI was calculated according to the formula: RAI = [(Post-TAVI BP amplitude)/(Post-TAVI SBP) − (Pre-TAVI BP amplitude)/(Pre-TAVI SBP)] × 100%, where BP is blood pressure and SBP is systolic blood pressure. Correlations of increased RAI with perioperative outcome were investigated and factors influencing mortality were isolated.The incidence of moderate and severe PAR after TAVI was 9% and 1%, respectively. Diastolic pressure or post-TAVI amplitude did not correlate to perioperative outcome. RAI increased from 2 when PAR was <2+ to 7 when PAR was ≥2+ (P = .006). A cut-off value of RAI ≥14 was associated with increased perioperative mortality (29 vs 5%; P = .013) and acute renal injury requiring dialysis (71 vs 18%; P = .001). RAI ≥14 was also associated with higher follow-up mortality at 1 year (57 vs 16%; P = .007). RAI ≥14 (odds ratio [OR], 3.390; 95% confidence interval [CI], 1.6-7.194; P = .00146), PAR ≥2+ (OR, 4.717; 95% CI, 1.828-12.195; P = .00135), and perioperative renal replacement therapy (OR, 12.820; 95% CI, 5.181-31.250; P = .00031) were found to be independent predictors of mortality at 1 year.The RAI is a useful tool to predict perioperative and 1-year outcome in patients with PAR after TAVI.

96/00148 Oil price shock ahead?

The impact of paravalvular aortic regurgitation (PAR) on hemodynamic performance after transcatheter aortic valve implantation (TAVI) remains disputable. Common parameters such as the diastolic blood pressure or the blood pressure amplitude do not provide reproducible results. The aim of our study was to evaluate the impact of PAR on hemodynamics and outcome using the relative amplitude index (RAI).PAR was prospectively evaluated by echocardiography before discharge in 110 patients. The RAI was calculated according to the formula: RAI = [(Post-TAVI BP amplitude)/(Post-TAVI SBP) − (Pre-TAVI BP amplitude)/(Pre-TAVI SBP)] × 100%, where BP is blood pressure and SBP is systolic blood pressure. Correlations of increased RAI with perioperative outcome were investigated and factors influencing mortality were isolated.The incidence of moderate and severe PAR after TAVI was 9% and 1%, respectively. Diastolic pressure or post-TAVI amplitude did not correlate to perioperative outcome. RAI increased from 2 when PAR was <2+ to 7 when PAR was ≥2+ (P = .006). A cut-off value of RAI ≥14 was associated with increased perioperative mortality (29 vs 5%; P = .013) and acute renal injury requiring dialysis (71 vs 18%; P = .001). RAI ≥14 was also associated with higher follow-up mortality at 1 year (57 vs 16%; P = .007). RAI ≥14 (odds ratio [OR], 3.390; 95% confidence interval [CI], 1.6-7.194; P = .00146), PAR ≥2+ (OR, 4.717; 95% CI, 1.828-12.195; P = .00135), and perioperative renal replacement therapy (OR, 12.820; 95% CI, 5.181-31.250; P = .00031) were found to be independent predictors of mortality at 1 year.The RAI is a useful tool to predict perioperative and 1-year outcome in patients with PAR after TAVI.