title: Can we predict postprocedural paravalvular leak after Edwards SAPIEN transcatheter aortic valve implantation?
abstract: BACKGROUND
  Postprocedural paravalvular leak (PVL) ≥ 2 has been shown to be associated with worse outcomes after transcatheter aortic valve implantation (TAVI). This study sought to identify predictive factors of postprocedural PVL ≥ 2 after TAVI with the Edwards valve.
  
  
  RESULTS
  A total of 176 patients with Edwards TAVI (aged 83.4 ± 7.4 years, Logistic EuroSCORE [the Logistic European System for Cardiac Operative Risk Evaluation] 18.8 ± 12.0, transfemoral 54.5%) who had preprocedural multidetector computed tomography (MDCT) were studied. A PVL ≥ 2 was observed in 12.5% of cases. By multivariate analysis, only the valve calcification index (VCI) defined as aortic root calcification volume/body surface area (odds ratio [OR] = 1.002, 95% confidence interval [CI] = 1.001-1.004, P = 0.006) and the valve diameter/the calculated average annulus diameter (CAAD) by MDCT (OR = 0.683, 95% CI = 0.474-0.984, P = 0.041) were identified as independent predictors of postprocedural PVL ≥ 2. A score predicting postprocedural PVL ≥ 2 (PVL score) was determined by allotting one point when the valve diameter/CAAD ratio was <1.055 and one point when VCI was >418.4 mm(3) /m(2) , and summing all points accrued. Area under receiver-operator characteristic curves of PVL score was 0.71 (95% CI = 0.59-0.83, P < 0.01). The incidence of PVL ≥ 2 was 5.3% in patients with a PVL score of 0, 11.8% for a PVL score of 1 and 37.5% for a PVL score of 2.
  
  
  CONCLUSIONS
  The only predictors of PVL ≥ 2 after Edwards valve implantation are the valve diameter/CAAD and VCI. The PVL score could prove to be an excellent tool for predicting the risk of PVL.
authors.affiliation: Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefèvre
authors.affiliation: Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Takahide
authors.initials: T
authors.lastname: Arai
authors.affiliation: Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashida
authors.affiliation: Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Erik
authors.initials: E
authors.lastname: Bouvier
authors.affiliation: Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hovasse
authors.affiliation: Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Mauro
authors.initials: M
authors.lastname: Romano
authors.affiliation: Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Chevalier
authors.affiliation: Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Garot
authors.affiliation: Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Donzeau-Gouge
authors.affiliation: Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Farge
authors.affiliation: Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Cormier
authors.affiliation: Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
mesh_terms: D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000175:diagnosis* / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000601:surgery; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*
keywords: aortic regurgitation; multidetector computed tomography; transcatheter aortic valve implantation