Abstract 15338: Determinants of Significant Paravalvular Regurgitation After Transcatheter Aortic Valve Implantation: Impact of Different Iterations of Devices and Degree of Valve Calcification
Objectives: The aim of this study is to assess the impact of iterations of balloon expandable valves (Sapien, Sapien XT and Sapien 3) and degree of aortic valve calcification (AVC) on the severity of paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI).
Hypothesis: The iterations of the Sapien prosthesis might impact the frequency and grade of PVR.
Methods: Multidetector computed tomography (MDCT) and echocardiographic examinations were performed in 262 patients (127 men, 81±7 years old, logistic EuroScore of 21±13%) who underwent TAVI with 23- and 26-mm balloon expandable valves. Patients receiving a 29-mm valves or undergoing valve-in-valve procedure were excluded. The degree of AVC was calculated with MDCT. PVR grade was assessed with echocardiography. The cover index was calculated as (prosthesis area- MDCT annulus area)/prosthesis area.
Results: Sapien, Sapien XT and Sapien 3 prostheses were implanted in respective 103 (39%), 105 (40%) and 54 (21%) patients. Significant PVR (≥moderate) occurred in 14% of patients receiving the Sapien prosthesis and 10% receiving a Sapien XT prosthesis but none in patients of the Sapien 3 group (p=0.019) (Figure 1). Across the groups (Sapien vs. Sapien XT vs. Sapien 3) the aortic annulus size (4.4±0.8 cm2 vs. 4.4±0.7cm2 vs. 4.3±0.7cm2, respectively; p=0.2), degree of calcification (7.7±0.6 Au vs. 7.8±0.7 Au vs. 8.0±0.6 Au, respectively; p=0.1) and cover index (88±16% vs. 90±11% vs. 90±10%, respectively; p=0.4) were comparable. Significant PVR was independently associated with higher degree of AVC (OR 2.89 p=0.02)and cover index (OR 1.08, p=0.03) after adjusting for age, body surface area, gender, aortic annulus area and prosthesis iteration.
Conclusions: The incidence of ≥moderate PVR significantly decreased over time with improvement in valve design. Significant PVR after TAVI remains independently associated with degree of AVC and cover index independently of the prosthesis iteration.
Author Disclosures: W.K. Kong: None. P. van Rosendael: None. F. van der Kley: None. A. de Weger: None. V. Kamperidis: None. M. Regeer: None. N. Ajmone Marsan: None. J. Bax: None. V. Delgado: Speakers Bureau; Modest; Abbott Vascular.
- © 2015 by American Heart Association, Inc.