Can we predict postprocedural paravalvular leak after Edwards SAPIEN transcatheter aortic valve implantation?. Issue 1 (19th March 2015)

• Record Type: Journal Article
• Authors: Watanabe, Yusuke; Lefèvre, Thierry; Arai, Takahide; Hayashida, Kentaro; Bouvier, Erik; Hovasse, Thomas; Romano, Mauro; Chevalier, Bernard; Garot, Philippe; Donzeau‐Gouge, Patrick; Farge, Arnaud; Cormier, Bertrand; Morice, Marie‐Claude
• Is Part Of: Catheterization and cardiovascular interventions. Volume 86:Issue 1(2015:Jul. 01)
• Page Start: 144
• Page End: 151
• Publication Date: 2015-03-19
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.25665
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ccd25665-sec-0001" sec-type="section"> <title>Background</title> <p>Postprocedural paravalvular leak (PVL) ≥ 2 has been shown to be associated with worse outcomes after transcatheter aortic valve implantation (TAVI). This study sought to identify predictive factors of postprocedural PVL ≥ 2 after TAVI with the Edwards valve.</p> </sec> <sec id="ccd25665-sec-0002" sec-type="section"> <title>Methods and Results</title> <p>A total of 176 patients with Edwards TAVI (aged 83.4 ± 7.4 years, Logistic EuroSCORE [the Logistic European System for Cardiac Operative Risk Evaluation] 18.8 ± 12.0, transfemoral 54.5%) who had preprocedural multidetector computed tomography (MDCT) were studied. A PVL ≥ 2 was observed in 12.5% of cases. By multivariate analysis, only the valve calcification index (VCI) defined as aortic root calcification volume/body surface area (odds ratio [OR] = 1.002, 95% confidence interval [CI] = 1.001–1.004, <italic>P</italic> = 0.006) and the valve diameter/the calculated average annulus diameter (CAAD) by MDCT (OR = 0.683, 95% CI = 0.474–0.984, <italic>P</italic> = 0.041) were identified as independent predictors of postprocedural PVL ≥ 2. A score predicting postprocedural PVL ≥ 2 (PVL score) was determined by allotting one point when the valve diameter/CAAD ratio was <1.055 and one point when VCI was >418.4 mm<sup>3</sup>/m<sup>2</sup>, and summing all points accrued. Area under receiver‐operator characteristic curves of PVL score was 0.71 (95% CI = 0.59–0.83, <italic>P</italic> < 0.01). The incidence of PVL ≥ 2 was 5.3% in patients with a PVL score of 0, 11.8% for a PVL score of 1 and 37.5% for a PVL score of 2.</p> </sec> <sec id="ccd25665-sec-0003" sec-type="section"> <title>Conclusions</title> <p>The only predictors of PVL ≥ 2 after Edwards valve implantation are the valve diameter/CAAD and VCI. The PVL score could prove to be an excellent tool for predicting the risk of PVL. © 2015 Wiley Periodicals, Inc.</p> </sec> </abstract>