Abstract 12189: Impact of CT guided Oversized Aortic Annulus Index (OAAI) for Evaluation of Paravalvular Regurgitation in Transcatheter Aortic Valve Replacement
[Introduction] Paravalvular regurgitation (PVR) is one of the important adverse effects in transcatheter aortic valve replacemaent (TAVR), in association with increased late mortality. Hence, to minimize PVR, appropriate annular measurements and prosthesis sizing are critical. Although determinants of PVR were reported associated with prosthesis/annulus congruence using transesophageal echocardiography (TEE) in Edwards SAPIEN heart-valve system (Edwards Lifesciences, Irvine, California), PVR has occurred frequently.
[Hypothesis] Development of efficiency of an ECG-gated, multi-slice computed tomography (MSCT) has made possible depict aortic annulus clearly. The aim of this study was to retrospectively evaluate prosthesis/annulus congruence using MSCT compared with TEE and its impact on the occurrence of PVR immediately after TAVR.
[Methods] Echocardiographic examinations were performed in 36 patients who underwent TAVR with Edwards SAPIEN. All patients were performed preoperative measurement of aortic annular diameter using MSCT. Congruence between annulus and device was appraised with the oversized aortic annulus index (OAAI) which divided by annulus diameter calculated from annulus perimeter using MSCT (OAAI(CT)) or TEE (OAAI(TEE)) to prosthesis diameter.
[Results] After TAVR, PVR ≤trace was found in 12 patients (33.3%) and PVR ≥mild in 24 (66.7 %). Occurrence of PVR ≤trace was significantly related to only larger OAAI(CT) (p=0.002) but not to other preoperative factors including OAAI(TEE) (p=0.28), age, device size, approaches, severity of stenosis, learning curve (differences from the first 18 cases to the last 18 cases), and so on. PVR ≤trace was never observed in patients with an OAAI(CT) >0.99. In receiver-operating characteristics (ROC) models, OAAI(CT) of 1.03 had the highest sum of sensitivity (75.0%) and specificity (91.7%) (areas under the curve: AUC=0.87), and OAAI(CT) had significantly higher discriminatory value for PVR than OAAI(TEE) (AUC=0.69) (p=0.028).
[Conclusions] The occurrence of PVR less than trace was significantly related to OAAI(CT), and OAAI(CT) was significantly higher discriminatory value for PVR than OAAI(TEE). This suggests that OAAI(CT) might be appropriate for evaluation of PVR in TAVR.
- © 2012 by American Heart Association, Inc.