Abstract 15598: The Ratio Between Bioprosthesis and CT-Measured Mean Annulus Diameter Predicts Significant Post-Procedural Aortic Regurgitation in Transcatheter Aortic Valve Implantation
Purpose: Post-procedural aortic regurgitation (AR) is known as an independent predictor for long-term mortality in transcatheter aortic valve implantation (TAVI), however the predictors for post-procedural AR and impact of CT-scan on this complication compared to transesophageal echography (TEE) still remain controversial. The purpose of this study was to identify the predictors for post-procedural AR including CT-scan indices.
Method: Among 337 consecutive TAVI cases in our institution, cardiac CT-scan to asses precisely the annulus size was performed in the last 109 cases which were included in this study. The CT-measured mean annulus diameter was calculated as: mDiam-CT=2√(annulus surface/π). Comparison of the clinical, echocardiographic and CT scan characteristics were performed by the existence of post-procedural AR ≥2 or not in order to identify the predictors of post-procedural.
Results: Patients were 83.5±5.8 years old with a logistic Euroscore of 23.9±11.5%. The Edwards valve was used in 92 cases (23mm in 32%, 26mm 58% and 29mm 19%) and Corevalve in 17 (26mm in 29% and 29mm in 71%). Univariate analysis identified lower body mass index (25.0±3.8 vs 26.1±4.6, p=0.048), smaller aortic valve area (0.56±0.13 vs 0.62±0.15, p=0.002), lower grade of pre-procedural AR (0.73±0.71 vs 0.93±0.71, p=0.033), a smaller valve diameter/mDiam-CT ratio” (1.08±0.07 vs 1.12±0.06, p=0.008) and valve diameter/largest Diam-CT ratio” (0.97±0.07 vs 1.01±0.06, p=0.018), transapical approach (22.7 vs 35.7%, p=0.019) and transaortic approach (0 vs 5.1%, p<0.001) significantly associated with post-procedural AR ≥2. Calcification score of annulus and valve by CT, “the valve / smallest Diam-CT ratio” and “the valve / Diam-TEE ratio” were not associated with post-procedural AR. Multivariate analysis revealed “the valve / mDiam-CT ratio” to be the only independent predictor for post-procedural AR ≥2 (HR 0.909 by increase of 0.01, 95%CI: 0.837-0.987, p=0.023). A valve / mDiam-CT ratio threshold of 1.10 (AUC=0.688) predicted a higher rate of post-procedural AR ≥2 (29.8% vs 11.3%, p=0.015).
Conclusion: The ratio between valve size / mDiam-CT was more accurate than Diam-TEE to predict post-procedural AR. Further application of CT-scan may decrease the risk of AR.
- © 2011 by American Heart Association, Inc.