title: Optimal sizing for SAPIEN 3 transcatheter aortic valve replacement in patients with or without left ventricular outflow tract calcification.
abstract: OBJECTIVE
  The impact of left ventricular outflow tract calcification (LVOT-CA) on SAPIEN 3 transcatheter aortic valve replacement (S3-TAVR) is not well understood. The aims of the present study were to determine optimal device sizing for S3-TAVR in patients with or without LVOT-CA and to evaluate the influence of residual paravalvular leak (PVL) on survival after S3-TAVR in these patients.
  
  
  RESULTS
  This study analysed 280 patients (LVOT-CA=144, no LVOT-CA=136) undergoing S3-TAVR. Optimal annular area sizing was defined as % annular area sizing related to lower rates of ≥mild PVL. Annular area sizing was determined as follows: (prosthesis area/CT annulus area-1)×100. Overall, ≥mild PVL was present in 25.7%. Receiver operating characteristic curve analysis for prediction of ≥mild PVL in patients with LVOT-CA showed that 7.2% annular area sizing was identified as the optimal threshold (area under the curve [AUC] 0.71). Conversely, annular area sizing for no LVOT-CA appeared unrelated to PVL (AUC 0.58). Aortic annular injury was seen in four patients (average 15.5% annular area oversizing), three of whom had LVOT-CA. Although there was no difference in one-year survival between patients with ≥mild PVL and without PVL (log-rank p=0.91), subgroup analysis demonstrated that patients with ≥moderate LVOT-CA who had ≥mild PVL had lower survival compared to patients with ≥mild PVL and none or mild LVOT-CA (log-rank p=0.010).
  
  
  CONCLUSIONS
  In the setting of LVOT-CA, an optimally sized S3 valve is required to reduce PVL and to increase survival following TAVR.
authors.affiliation: Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA, USA.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Maeno
authors.forename: Yigal
authors.initials: Y
authors.lastname: Abramowitz
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.forename: Sharjeel
authors.initials: S
authors.lastname: Israr
authors.forename: Sunghan
authors.initials: S
authors.lastname: Yoon
authors.forename: Rahul P
authors.initials: RP
authors.lastname: Sharma
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kazuno
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kawamori
authors.forename: Masaki
authors.initials: M
authors.lastname: Miyasaka
authors.forename: Tanya
authors.initials: T
authors.lastname: Rami
authors.forename: Geeteshwar
authors.initials: G
authors.lastname: Mangat
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Takahashi
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Okuyama
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kashif
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.forename: Mamoo
authors.initials: M
authors.lastname: Nakamura
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D002114:Calcinosis / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D011183:Postoperative Complications / Q000209:etiology; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D014694:Ventricular Outflow Obstruction