Abstract 13600: Can we Predict Post-Procedural Paravalvular Leak After Edwards Sapien Transcatheter Aortic Valve Implantation
Objectives: This study sought to identify predictive factors of post-procedural paravalvular leak (PVL) ≥2 after transcatheter aortic valve implantation (TAVI) with the Edwards valve.
Background: Post-procedural PVL ≥ 2 has been shown to be associated with worse mid-term outcomes after TAVI. Valve calcification and optimal valve sizing may play an important role in this setting.
Methods and Results: A total of 176 Edwards TAVI patients (aged 83.4±7.4 years, Logistic EuroSCORE 18.8±12.0, transfemoral 54.5%) who had preprocedural multislice computed tomography (MSCT) were studied. In order to assess the role of valve calcification, a new Valve Calcification Index (VCI) was defined using MSCT as aortic root calcification volume / aortic annulus area. Optimal valve sizing was defined as the valve diameter / calculated annulus average diameter (CAAD) by MSCT. After post dilatation, performed in 16.7% of cases, a PVL ≥ 2 was observed in only 12.5% of cases. The 1-year estimated survival of both PVL < 2 and PVL ≥ 2 groups were 95.3±2.1% vs 79.0±10.8% (log-rank p=0.02), respectively. Only the VCI, odds ratio [OR] 2.11, 95% confidence interval [CI] 1.27 to 3.51, p<0.01) and the valve diameter / CAAD (OR 0.57, 95% CI 0.38 to 0.87, p=0.01), were identified as independent predictors of post-procedural PVL ≥ 2. A score predicting post-procedural PVL ≥ 2 (PVL score) was determined by assigning one point when the Valve / CAAD ratio was < 1.05 and one point when VCI was > 2.05, and summing all points accrued. Area under receiver-operator characteristic curves of PVL score were 0.70 (95% CI 0.58 to 0.82, p<0.01). The incidence of PVL ≥ 2 in patients with a PVL score of 0 was 5.5%, 1 was 16.7% and 2 was 38.5%, respectively.
Conclusions: The only predictors of PVL ≥ 2 after Edwards valve implantation are the valve diameter / CAAD and VCI. The use of these two simple parameters could become an excellent tool to predict the risk of PVL.
- © 2013 by American Heart Association, Inc.