title: Non-invasive and invasive predictors of paravalvular regurgitation post CoreValve® stent prosthesis implantation in aortic valves.
abstract: OBJECTIVE
  The long-term success of CoreValve® stent prosthesis (Medtronic) implantation for severe aortic valve stenosis is limited by postprocedural paravalvular regurgitation (PVR).
  
  
  METHODS
  We have retrospectively investigated preinterventional cardiac 256-slice computed tomography (CT) scans and aortography to define predictors for mild, moderate, or severe PVR, in a blinded fashion.
  
  
  RESULTS
  We investigated 100 consecutive patients with a mean aortic valve area (AVA) of 0.69 cm(2) and a mean age of 79.4 years. PVR was defined by echocardiography as mild (63), moderate (18), or severe (19). We found no differences according to AVA, left ventricular function, deployed stent size, calcification rate of the aortic valve, and stent position. Anatomically, the annular size and the angle between the left ventricular outflow tract (LVOT) and the ascending aorta demonstrated significant (P < 0.05) differences in the severity of the PVR: an LVOT: ascending aorta angle >12.6°, annulus area >8.9 cm(2) , and annulus diameter difference >3.9 mm. The multivariate analysis demonstrated that deviation angle, difference of aortic annulus (longitudinal-orthogonal), and CoreValve size were independent predictors of PVR.
  
  
  CONCLUSIONS
  Our data demonstrate the feasibility of cardiac CT to evaluate predictors of PVR post-CoreValve placement. We support the aortic annulus (the area as well as the diameter differences) and the deviation of the linear slope from LVOT to ascending aorta as predictors of severe paravalvular regurgitations poststent implantation.
authors.affiliation: Department of Cardiology, Division of Medicine, Klinikum Calw-Nagold, Kliniken Calw, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Anger
authors.forename: Verena
authors.initials: V
authors.lastname: Bauer
authors.forename: Claudia
authors.initials: C
authors.lastname: Plachtzik
authors.forename: Tobias
authors.initials: T
authors.lastname: Geisler
authors.forename: Meinrad
authors.initials: M
authors.lastname: Gawaz
authors.forename: Martin
authors.initials: M
authors.lastname: Oberhoff
authors.forename: Martin
authors.initials: M
authors.lastname: Höher
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery; D001027:Aortography / Q000379:methods; D002114:Calcinosis; D004452:Echocardiography / Q000379:methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis; D017755:Prosthesis Fitting / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects*