Abstract 16274: Multidetector Row Computed Tomography to Assess Underlying Mechanisms of Paravalvular Aortic Regurgitation Following Transcatheter Aortic Valve Implantation
Introduction. The underlying mechanisms of paravalvular aortic regurgitation (PAR) after transcatheter aortic valve implantation (TAVI) remain unclear. Pre-procedural multidetector row computed tomography (MDCT) has provided some predictors of PAR. However, information on the deployment and apposition of the prosthetic frame provided by post-procedural MDCT may also help to understand the pathophysiology of PAR.
Hypothesis. We aimed at evaluating pre- and post-procedural MDCT predictors of PAR after TAVI.
Methods. In total 123 patients(male 60(48%),age 81(SD7.2), logEuroscore 23.1(SD14)) referred for TAVI underwent pre- and post-operative MDCT and transthoracic echocardiography evaluation. PAR was assessed one month after the procedure and considered significant if it was more than mild.
Results. Significant PAR was present in 25 (20.3%) patients.Univariate predictors of PAR were the MDCT maximal annulus (HR 1.177, 95% CI 0.973-1.424,p=0.094),the difference between the maximum native aortic annulus diameter measured on MDCT and the nominal diameter of the prosthesis (HR 1.398, 95% CI 1.122-1.741, p=0.003), the prosthesis frame eccentricity (HR 2.779, 95% CI 0.900-8.577, p=0.075) and a shallow position of the device (depth of the frame in the LVOT<2mm) (HR 5.056, 95% CI 1.580-16.18, p=0.006). The difference between the maximum native aortic annulus diameter and the nominal diameter of the prosthesis (HR 1.912, 95% CI 1.257-2.908, p=0.002) and shallow position of the device (HR 4.865, 95% CI1.331-17.786, p=0.017) were independent predictors of PAR. Receiver operating curve analysis revealed that a difference of 2 mm between maximum annulus diameter and nominal prosthesis diameter had a 76% sensitivity and 63% specificity to predict PAR (AUC 0.723, 95% CI 0.623-0.823, p=0.001).
Conclusion. In patients undergoing TAVI, the difference between the maximum aortic annulus diameter measured on pre-procedural MDCT and the nominal diameter of the prosthesis and also depth of the frame in the LVOT<2mm -assessed by post-operative MDCT- are independently associated with PAR.
- © 2012 by American Heart Association, Inc.