title: Relationship of aortic annular eccentricity and paravalvular regurgitation post transcatheter aortic valve implantation with CoreValve.
abstract: BACKGROUND
  Significant paravalvular aortic regurgitation (PAR) after transcatheter aortic valve implantation (TAVI) is associated with negative clinical consequences. We hypothesize that increased eccentricity of the aortic annulus is associated with greater PAR.
  
  
  METHODS
  Patients with severe aortic stenosis underwent multidetector computed tomography (MDCT) before successful TAVI with the Medtronic CoreValve bioprosthesis. The smallest (D(min)) and largest (D(max)) orthogonal diameters in the basal ring of the aortic annulus were determined. We defined circularity of aortic annulus using the eccentricity index (1 - D(min)/D(max)). The primary endpoint was early occurrence of significant PAR, defined as > grade II PAR by postprocedural aortography.
  
  
  RESULTS
  Eighty-four patients, mean age 83 ± 4 years with a mean aortic valve area of 0.7 ± 0.2 cm² were included. Twenty patients had postprocedural PAR > grade II. Using a receiver operating characteristic (ROC) analysis, eccentricity index correlated with significant PAR (AUC = 0.834; P=.034). A retrospectively determined eccentricity index cut-off of >0.25 was related to significant PAR with a sensitivity of 80%, specificity of 86%, and negative predictive value of 95% (P<.001). On univariate logistic regression, eccentricity index of >0.25 (P<.001) and device implantation depth (P=.015) correlated with significant PAR, while other parameters such as annular calcification and cover index did not. On multivariate analysis including only parameters with P<.1 on univariate analysis, eccentricity index >0.25 was the sole independent predictor of significant PAR.
  
  
  CONCLUSIONS
  Eccentricity index is related to significant PAR after TAVI with Medtronic CoreValve. Further larger studies are required to determine the utility of this novel index in screening suitable patients for this procedure.
authors.affiliation: Cardiovascular Research Centre, Royal Adelaide Hospital & Discipline of Medicine, University of Adelaide, Adelaide, Australia.
authors.forename: Dennis T L
authors.initials: DT
authors.lastname: Wong
authors.forename: Angela G
authors.initials: AG
authors.lastname: Bertaso
authors.forename: Gary Y H
authors.initials: GY
authors.lastname: Liew
authors.forename: Viji S
authors.initials: VS
authors.lastname: Thomson
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cunnington
authors.forename: James D
authors.initials: JD
authors.lastname: Richardson
authors.forename: Robert
authors.initials: R
authors.lastname: Gooley
authors.forename: Siobhan
authors.initials: S
authors.lastname: Lockwood
authors.forename: Ian T
authors.initials: IT
authors.lastname: Meredith
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Worthley
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Worthley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology*; D001024:Aortic Valve Stenosis / Q000628:therapy*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000379:methods*; D058385:Cardiac Valve Annuloplasty / Q000379:methods*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D012372:ROC Curve; D012189:Retrospective Studies