Does frame geometry play a role in aortic regurgitation after Medtronic CoreValve implantation?
OBJECTIVE
Aortic regurgitation (AR) after Medtronic CoreValve System (MCS) implantation may be explained by patient-, operator- and procedure-related factors. We sought to explore if frame geometry, as a result of a specific device-host interaction, contributes to AR.


RESULTS
Using rotational angiography with dedicated motion compensation, we assessed valve frame geometry in 84 patients who underwent TAVI with the MCS. Aortic regurgitation was assessed by angiography (n=84, Sellers) and echocardiography at discharge (n=72, VARC-2). Twenty-two patients (26%) had AR grade ≥2 using contrast angiography, and 17 (24%) by echocardiography. Balloon predilatation and sizing and depth of implantation did not differ between the two groups. Despite more frequent balloon post-dilatation in patients with AR (40.9 vs. 9.7%, p=0.001), the frame was more elliptical at its nadir relative to the patient's annulus (6±13 vs. -1±11%, p=0.046) and occurred in a larger proportion of patients (61.9 vs. 26.8%, p=0.004). Although the Agatston score and the eccentricity of the MCS frame relative to the annulus were independent determinants of AR (odds ratio: 1.635 [1.151-2.324], p=0.006, and 4.204 [1.237-14.290], p=0.021), there was a weak association between the Agatston score and the adjusted eccentricity (Spearman's rank correlation coefficient =-0.24, p=0.046).


CONCLUSIONS
These findings indicate that AR can be explained by a specific device-host interaction which can only partially be explained by the calcium load of the aortic root.
Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Ramón
R
Rodríguez-Olivares
Nahid
N
El Faquir
Zouhair
Z
Rahhab
Patrick
P
Geeve
Anne-Marie
AM
Maugenest
Sander
S
van Weenen
Ben
B
Ren
Tjebbe
T
Galema
Marcel
M
Geleijnse
Nicolas M
NM
Van Mieghem
Ron
R
van Domburg
Nico
N
Bruining
Carl
C
Schultz
Guenter
G
Lauritsch
Peter P T
PP
de Jaegere
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome