title: Determinants of aortic regurgitation after transcatheter aortic valve implantation. An observational study using multi-slice computed tomography-guided sizing.
abstract: BACKGROUND
  The aim of this paper was to explore the determinants of aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) using multi-slice computed tomography (MSCT) instead of echocardiography-guided sizing.
  
  
  METHODS
  Determinants of AR were assessed in 313 consecutive patients who underwent TAVI with the Medtronic (MCS, N.=259) or Edwards Sapien or XT (ESV, N.=54) using MSCT-guided sizing. AR was assessed by angiography immediately after TAVI (N.=313, Sellers) and by echocardiography at discharge (N.=285, VARC-2). Distinction was made between patients with grade 0-1 and grade ≥2 AR post-TAVI.
  
  
  RESULTS
  AR≥2 post-TAVI was seen in 91 patients or 29% (MCS 85/259: 33% vs. ESV 6/54:11%) by angiography and 94 patients or 33% (MCS 87/239:36% vs. ESV 7/46:15%) by echocardiography. By univariable analysis, patients with AR≥2 post TAVI had more AR≥2 at baseline (70% vs. 52%, P=0.003), a larger mean and maximal annulus diameter (25.0 [23.5-26.3] vs. 24.0 [22.6-26.0], P=0.025 and 27.9±2.7 mm vs. 27.0±2.8 mm, P=0.018, respectively) and a higher Agatston Score (3.9 [2.9-5.3] vs. 2.6 [1.8-3.8], P≤0.001). AR≥2 post-TAVI was more frequent after MCS than ESV (33% vs. 11%, P=0.001). There was no difference in nominal valve size relative to the patient's annulus, nor depth of implantation. By propensity score adjusted multivariable analysis, AR≥2 at baseline (odds 2.407 [95% CI: 1.472-3.938]) but above all MCS (odds: 6.047 [95% CI; 1.307- 27.976]) were independent determinants of AR≥2 post-TAVI. The latter was also confirmed by propensity score adjusted multivariable analysis in the echocardiography population (N.=285) (odds: 5.259 [95% CI; 1.070-25.851]).
  
  
  CONCLUSIONS
  AR≥2 is more prevalent after MCS valve implantation and is an independent determinant of AR also when using MSCT guided-sizing.
authors.affiliation: Department of Cardiology and Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Zouhair
authors.initials: Z
authors.lastname: Rahhab
authors.affiliation: Department of Cardiology and Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Nahid
authors.initials: N
authors.lastname: El Faquir
authors.affiliation: Department of Cardiology and Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Ramón
authors.initials: R
authors.lastname: Rodríguez-Olivares
authors.affiliation: Department of Cardiology and Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Claire
authors.initials: C
authors.lastname: Ren
authors.affiliation: Department of Cardiology and Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Nicolas
authors.initials: N
authors.lastname: van Mieghem
authors.affiliation: Department of Cardiology and Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Marcel L
authors.initials: ML
authors.lastname: Geleijnse
authors.affiliation: Department of Cardiology, Royal Perth Hospital Campus, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
authors.forename: Carl
authors.initials: C
authors.lastname: Schultz
authors.affiliation: Department of Cardiology and Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Ron
authors.initials: R
authors.lastname: van Domburg
authors.affiliation: Department of Cardiology and Radiology, Erasmus Medical Center, Rotterdam, The Netherlands - p.dejaegere@erasmusmc.nl.
authors.forename: Peter P
authors.initials: PP
authors.lastname: de Jaegere
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation*; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D016015:Logistic Models; D008297:Male; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D057216:Propensity Score; D011474:Prosthesis Design; D012307:Risk Factors; D016896:Treatment Outcome