Anatomical risk models for paravalvular leak and landing zone complications for balloon‐expandable transcatheter aortic valve replacement

Condado, José F.; Corrigan, Frank; Parastatidis, Ioannis; Stillman, Arthur E.; Binongo, José; Stewart, James; Mavromatis, Kreton; Devireddy, Chandan; Leshnower, Bradley G.; Guyton, Robert A.; Forcillo, Jessica; Patel, Ateet; Thourani, Vinod H.; Block, Peter C.; Babaliaros, Vasilis

doi:10.1002/ccd.26987

Cited by 19 publications

(14 citation statements)

References 26 publications

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“…Comparison of predictive performance between FD and known predictors of PVR based on our data is difficult due to relatively low numbers of patients and events and the absence of large trials evaluating PVR predictors in second generation valves. However, the AUC of 0.66 for PVR prediction is roughly of the same magnitude as the AUC of previously published models, which were mostly between 0.635 and 0.72 [7,21,26].…”

Section: Discussionsupporting

confidence: 76%

“…Paravalvular regurgitation (PVR) remains an important drawback of transcatheter aortic valve implantation (TAVI) with negative prognostic implications for the patient [1][2][3]. Apart from procedural causes, its incidence depends on sealing zone anatomy, quantified for example by measures of calcium protrusion into the lumen [4], semiquantitatively graded calcium bulks [5] or landing zone eccentricity or nontubularity [6,7]. However, these predictors could not be substantiated in all studies, and an objective quantification of 'disadvantageous anatomy ' has not yet been developed.…”

Section: Introductionmentioning

confidence: 99%

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Fractal dimension of the aortic annulus: a novel predictor of paravalvular leak after transcatheter aortic valve implantation

Stachel

Abdel‐Wahab

Waha‐Thiele

et al. 2022

Int J Cardiovasc Imaging

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To evaluate the prognostic relevance of aortic annulus (AA) and left ventricular outflow tract (LVOT) Fractal dimension (FD). FD is a mathematical concept that describes geometric complexity of a structure and has been shown to predict adverse outcomes in several contexts. Computed tomography (CT) scans from the SOLVE-TAVI trial, which, in a 2 × 2 factorial design, randomized 447 patients to TAVI with the balloon-expandable Edwards Sapien 3 or the self-expanding Medtronic Evolut R, and conscious sedation or general anesthesia, were analyzed semi-automatically with a custom-built software to determine border of AA and LVOT. FD was measured by box counting using grid calibers between 0.8 and 6.75 mm and was compared between patients with none/trivial and mild/moderate paravalvular regurgitation (PVR). Overall, 122 patients had CT scans sufficient for semi-automatic PVR in 30-day echocardiography. PVR was none in 65(53.3%) patients, trace in 9(7.4%), mild in 46(37.7%), moderate in 2(1.6%) and severe in 0 patients. FD determined in diastolic images was significantly higher in patients with mild/moderate PVR (1.0558 ± 0.0289 vs. 1.0401 ± 0.0284, p = 0.017). Annulus eccentricity was the only conventional measure of AA and LVOT geometry significantly correlated to FD (R = 0.337, p < 0.01). Area under the curve (AUC) of diastolic annular FD for prediction of mild/moderate PVR in ROC analysis was 0.661 (0.542–0.779, p = 0.014). FD shows promise in prediction of PVR after TAVI. Further evaluation using larger patient numbers and refined algorithms to better understand its predictive performance is warranted.Trial Registration:www.clinicaltrials.gov, identifier: NCT02737150, date of registration: 13.04.2016.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Fractal dimension of the aortic annulus: a novel predictor of paravalvular leak after transcatheter aortic valve implantation

Stachel

Abdel‐Wahab

Waha‐Thiele

et al. 2022

Int J Cardiovasc Imaging

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“…Annular cover index was calculated as follows: ([THV area × area of the annulus/THV area] × 100). Annular ellipticity was calculated as ([maximum annular diameter − minimum annular diameter/maximum annular diameter] × 100) and LVOT nontubularity as ([annular area − LVOT area/annular area] × 100) using a method introduced by Condado et al [11].…”

Section: Msct Acquisition and Image Analysismentioning

confidence: 99%

Incidence, Predictors, and Outcome of Paravalvular Leak after Transcatheter Aortic Valve Implantation

Hagar

Wei

et al. 2020

Journal of Interventional Cardiology

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Background. Paravalvular leak (PVL) is common after transcatheter aortic valve implantation (TAVI) and has been linked with worse survival. This study aimed to investigate the determinants and outcome of PVL after TAVI and determine the role of aortic valve calcification (AVC) distribution in predicting PVL. Methods and Results. This was a retrospective cohort study of 270 consecutive patients who underwent TAVI. Determinants and outcomes of ≥mild PVL were assessed. Matching rates of PVL jet with AVC distribution were calculated. AVC volume, larger annulus dimensions, and transvalvular peak velocity were risk factors for ≥mild PVL after TAVI. AVC volume was an independent predictor of ≥mild PVL. On the other hand, annulus ellipticity, left ventricular outflow tract nontubularity, and diameter-derived prosthesis mismatch were not found to predict PVL after TAVI. PVL jet matched, in varying proportions, with calcification at all aortic root regions, and the highest matching rate was with calcifications at body of leaflets. Moreover, matching rates were less with commissure compared to cusp calcifications. Mild or greater PVL was not associated with all-cause and cardiovascular mortality up to 1-year follow-up. Conclusion. ≥mild PVL after TAVI is common and can be predicted by aortic root calcification volume, larger annulus dimensions, and pre-TAVI transvalvular peak velocity, with calcification volume being an independent predictor for PVL. However, annulus ellipticity, left ventricular outflow tract nontubularity, and diameter-derived prosthesis mismatch had no role in predicting PVL. Importantly, body of leaflet calcifications (versus annulus and tip of leaflet) and cusp calcifications (versus commissure calcification) are more important in predicting PVL. No association between ≥mild PVL and increased risk of all-cause and cardiovascular mortality at 1-year follow-up.

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“…Preoperative CT assessment of patients with severe AS who have qualified for TAVR is obligatory and enables accurate procedure planning and correct device selection. CT assessment makes it possible to reduce the number of postoperative complications such as the occurrence of PVL (15)(16)(17)(18)(19)(20). Severe AVC is one of the factors that makes PVL more likely after TAVR, which is why it is obligatory to assess AVC degree in CT (21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

Paravalvular leak prediction after transcatheter aortic valve replacement with self-expandable prosthesis based on quantitative aortic calcification analysis

Wiktorowicz¹,

Wit²,

Malinowski³

et al. 2021

Quant Imaging Med Surg

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Background: Paravalvular leak (PVL) is one of the most common complications of transcatheter aortic valve replacement (TAVR) and affects short-and long-term outcomes. The aim of this study was to identify the computed tomography (CT) imaging biomarkers that allow PVL after TAVR to be predicted.Methods: Patients were included who had severe aortic valve stenosis, had undergone TAVR with a selfexpanding valve, and had undergone a pre-procedural CT scan. Data on baseline characteristics, procedural and long-term outcomes were collected retrospectively. We used MATLAB software with a self-developed algorithm for CT scan analysis and found parameters that quantified aortic valve calcifications (AVC) in detail.Results: Fifty patients were included. The identified CT-derived parameters included AVC size, volume, thickness and density, as well as calcium radial distribution. The volume of the largest calcium block, calcium perimeter and calcium size (assessed by Feret's diameter) showed a strong association with PVL occurrence after TAVR (P=0.012, P=0.001 and P=0.045, respectively). The prognostic model showed that a 10 mm 2 increase in the local AVC amount in each valve section was associated with a 9.8% (95% CI: 2-18%; P=0.019) increase in the risk of PVL occurrence in the corresponding area after TAVR. ROC analysis revealed that the cut-off point of the AVC area was 96.5 mm 2 in the polar coordinate system presentation. Kaplan-Meier curves showed worse PVL-free survival in patients with more than 96.5 mm 2 of calcium area (P=0.013; log-rank).Conclusions: Quantitative AVC assessment for PVL prediction may play an important role in screening before TAVR. In future, the use of quantitative AVC assessment as an imaging biomarker in TAVR candidates and the creation and extension of an online database containing quantitative AVC parameters may help to identify high PVL risk patients.

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Anatomical risk models for paravalvular leak and landing zone complications for balloon‐expandable transcatheter aortic valve replacement

Abstract: A model using procedural/anatomical characteristics derived from MDCT predicts ≥mild PVL, ≥moderate PVL, and LZ complications post-TAVR. Incorporation of anatomical risks into clinical practice may help stratify patients before TAVR. © 2017 Wiley Periodicals, Inc.

Cited by 19 publications

References 26 publications

Fractal dimension of the aortic annulus: a novel predictor of paravalvular leak after transcatheter aortic valve implantation

Fractal dimension of the aortic annulus: a novel predictor of paravalvular leak after transcatheter aortic valve implantation

Incidence, Predictors, and Outcome of Paravalvular Leak after Transcatheter Aortic Valve Implantation

Paravalvular leak prediction after transcatheter aortic valve replacement with self-expandable prosthesis based on quantitative aortic calcification analysis

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