title: Correlation of CoreValve implantation 'true cover index' with short and mid-term aortic regurgitation: A novel index.
abstract: BACKGROUND
  'Cover index' has been proposed to appraise the congruence between the aortic annulus and the device, with the assumption of not taking into account the actual device implantation depth. The aim of this study was to investigate whether the annulus-prosthesis mismatch, as expressed with the new proposed 'true cover index' according to actual implantation depth, can predict aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI).
  
  
  METHODS
  Patients who had undergone TAVI with the self-expandable CoreValve device, were retrospectively studied. All available prosthesis sizes were ex-vivo scanned and the precise diameter at 0.3mm intervals along each device was measured. The 'true cover index' was evaluated, as a ratio of the following: 100×([prosthesis actual diameter at implantation depth-annulus diameter]/prosthesis actual diameter at implantation depth). AR was echocardiographically evaluated at discharge and 30days and classified as prominent if moderate, or trivial if none or mild.
  
  
  RESULTS
  Overall, 120 patients who had undergone TAVI, were considered eligible for the study. 'True cover index' was statistically significantly lower among patients with prominent AR in comparison with trivial AR at discharge (5.7±4.8mm vs 9±5.1, p=0.025), as well as at one month post-TAVI (5.4±5.1mm vs 9.0±5.1, p=0.023), indicating increased AR for smaller index. After adjustment for severe annulus calcification, impaired baseline LVEF and previous valvuloplasty, it remained an independent predictor of one month prominent AR (OR: 0.854, CI: 0.730-0.999; p=0.048). 'True cover index' of <4.3 was shown to predict one-month prominent AR with sensitivity =75% and specificity =82.5%.
  
  
  CONCLUSIONS
  'True cover index' is strongly and independently correlated with the short and mid-term AR after CoreValve implantation.
authors.affiliation: 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece. Electronic address: vavouran@otenet.gr.
authors.forename: Manolis
authors.initials: M
authors.lastname: Vavuranakis
authors.affiliation: 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece. Electronic address: kalogerask@yahoo.gr.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kalogeras
authors.affiliation: 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Lavda
authors.affiliation: 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece.
authors.forename: Michail-Aggelos
authors.initials: MA
authors.lastname: Kolokathis
authors.affiliation: 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Papaioannou
authors.affiliation: 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece.
authors.forename: Euaggelos
authors.initials: E
authors.lastname: Oikonomou
authors.affiliation: Radiology Department, 'Agios Savvas' Hospital, Athens, Greece.
authors.forename: Mursini
authors.initials: M
authors.lastname: Stasinopoulou
authors.affiliation: 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Vrachatis
authors.affiliation: 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece.
authors.forename: Carmen
authors.initials: C
authors.lastname: Moldovan
authors.affiliation: 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Kariori
authors.affiliation: 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece.
authors.forename: Evelina
authors.initials: E
authors.lastname: Bei
authors.affiliation: 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece.
authors.forename: Sophia
authors.initials: S
authors.lastname: Vaina
authors.affiliation: 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Lazaros
authors.affiliation: 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece.
authors.forename: Ourania
authors.initials: O
authors.lastname: Katsarou
authors.affiliation: 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Siasos
authors.affiliation: 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tousoulis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D006328:Cardiac Catheterization; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D061330:Multidetector Computed Tomography; D011379:Prognosis; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*
keywords: Aortic regurgitation; Cover index; Implantation depth; TAVI