Risk factors for paravalvular leak after transcatheter aortic valve replacement

Abstract

Objective. To assess risk factors for paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) in a large single-center cohort, including measurement of aortic valve calcification using a reproducible method. Methods. We retrospectively analyzed preoperative contrast-enhanced multidetector computed tomography (MDCT) scans of patients who underwent TAVI in our center between 2009 and 2016. Calcium volume was calculated for each aortic cusp in the aortic valve (AV), left ventricular outflow tract (LVOT) and device-landing zone (DLZ). Results. Overall, 539 patients were included in the study (Edwards SapienXT, n=192; Edwards Sapien3, n=206; Medtronic CoreValve EvolutR, n=44; Symetis Acurate, n=97). Median calcium volume in the DLZ was 757 mm 3 , with no significant differences among the four prosthesis groups. None of the patients had severe PVL. The overall incidence of mild-to-moderate PVL was 15.8% (95% CI: 12.8-19.1%). On multivariate logistic regression, DLZ calcification (p=0.00006; OR for an increase of 100 mm 3 1.08; 95% CI: 1.04-1.13) and use of the CoreValve (p=0.0028; OR 4.1; 95% CI: 1.6-10 with SapienXT as reference) prosthesis were found to be associated with ≥mild PVL. In contrast, degree of oversizing (p=0.002; OR 0.97; 95% CI: 0.95-0.99), and use of Sapien3 (p=0.00005; OR 0.23; 95% CI: 0.11-0.47 with SapienXT as reference) were associated with a lower incidence of ≥mild PVL. Conclusions. Aortic calcification volume in the DLZ is associated with residual PVL after TAVI. When taking calcification into account, the balloon-expandable prosthesis Sapien3 seems to be associated with a lower incidence of PVL.

Transcatheter, sutureless and conventional aortic-valve replacement: a network meta-analysis of 16,432 patients

“…Technological developments in TAVI technology include the introduction of a polyethylene terephthalate outer skirting in the SAPIEN 3 prosthesis (Edwards Lifesciences, Irvine, California) with the goal of increasing contact and adhesion of the valve against the aortic annulus (50). Clinical results suggest that the SAPIEN 3 prosthesis is associated with a lower incidence of paravalvular leak compared to SAPIEN XT (Edwards Lifesciences) and CoreValve EvolutR (Medtronic, Minneapolis, Minnesota) (51). Future larger studies with longer follow-up will be required to demonstrate whether these differences have a significant clinical effect.…”

Effect of postdilatation following balloon expandable transcatheter aortic valve implantation

“…Fifth, we did not quantify the degree of aortic calcification. Postdilatation was more often performed in patients with high calcium degree, resulting in higher incidences of paravalvular leakage and atrioventricular block 25 . Furthermore, patients with larger recoil tended to have a greater Agatston calcium scores 17 .…”

“…Postdilatation was more often performed in patients with high calcium degree, resulting in higher incidences of paravalvular leakage and atrioventricular block. 25 Furthermore, patients with larger recoil tended to have a greater Agatston calcium scores. 17 Calcium amount could be a confounder for the recoil effect observed in our study.…”

Transthoracic vs. transesophageal echocardiography in transcatheter aortic valve implantation: a systematic review and meta-analysis

“…Although there were no significant differences in baseline characteristics, including surgical risk scores, observational studies inherently include a risk of confounding variables. For example, PVL is influenced by many factors such as the type of prosthesis used, differences in procedural technique and center experience [29] . However, mode of anesthesia is the most concerning confounding variable.…”