Paravalvular leak after transcatheter aortic valve implantation: is it anatomically predictable or procedurally determined? MDCT study.
OBJECTIVE
To investigate the determinants of paravalvular leak (PVL) occurring after transcatheter aortic valve implantation (TAVI).


METHODS
One hundred and eight patients with severe symptomatic aortic stenosis (mean age 75.5±11.8 years, 72.2% male) underwent contrast-enhanced electrocardiogram (ECG)-gated multidetector computed tomography (MDCT) then successful TAVI. The following parameters were determined in the late systolic phase: annular and left ventricular outflow tract (LVOT) diameters, annular perimeter, ellipticity index, annular area, indexed annular area, LVOT perimeter, annulus/LVOT perimeter difference ratio, the LVOT to ascending aorta angle (< LVOT-AO). In the diastolic phase, the extent of calcification of the aortic valve (AVC) was assessed visually and graded semi-quantitatively as grade I, II, and III at the annulus, LVOT, and aortic cusps levels. Pre-discharge transthoracic echocardiography (TTE) was performed, and the PVL was graded as grade I, II, and III. The area-dependent device-annulus sizing ratio was calculated.


RESULTS
Absence of PVL was observed in 44.44% of the patients, 30.56% had grade I PVL, 25% of the patients had grade II or above, and any PVL was observed in 55.56%. There was no statistically significant association between the degree of PVL and the extent or the distribution of AVC, aortic annulus diameters, ellipticity index, annulus/LVOT perimeter difference ratio or < LVOT-AO. The frequency of PVL was not significantly different with the use of balloon-expandable or self-expandable valves. A larger transcatheter heart valve (THV)/annulus sizing ratio was associated with a lower incidence and degree of PVL (p<0.001); there was no detectable PVL with a mean sizing ratio of 14.89±7.29, and grade I PVL occurred with a mean sizing ratio 12.43±0.84, while PVL of grade II or above occurred using the mean sizing ratio -0.42±5.57.


CONCLUSIONS
The procedure-related THV/annulus sizing ratio was an important determinant of the degree of PVL after TAVI, whereas the MDCT-derived anatomical measurements of the aortic root and AVC were not predictors of PVL.
Madina Cardiac Center, 23411, AL Madinah Al Munawwrah, Khaled Bin Al Waleed Road, Saudi Arabia; Department of Diagnostic and Interventional Radiology, Mansoura University Hospital, 35112, 12 El-Gomhoreya Street, Mansoura, Egypt. Electronic address: amlsakrana@yahoo.com.
A A
AA
Sakrana
Department of Diagnostic and Interventional Radiology, Mansoura University Hospital, 35112, 12 El-Gomhoreya Street, Mansoura, Egypt.
M M
MM
Nasr
Department of Diagnostic and Interventional Radiology, Mansoura University Hospital, 35112, 12 El-Gomhoreya Street, Mansoura, Egypt.
G A
GA
Ashamallah
Madina Cardiac Center, 23411, AL Madinah Al Munawwrah, Khaled Bin Al Waleed Road, Saudi Arabia.
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RA
Abuelatta
Madina Cardiac Center, 23411, AL Madinah Al Munawwrah, Khaled Bin Al Waleed Road, Saudi Arabia.
H A
HA
Naeim
Zagazig University Hospital, Cardiology Department, Zagazig, Egypt.
M E
ME
Tahlawi
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000175:diagnosis*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D003287:Contrast Media; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis*; D011856:Radiographic Image Enhancement; D065467:Transcatheter Aortic Valve Replacement
D003287:Contrast Media