Predictors of paravalvular leak following implantation of the ACURATE neo transcatheter heart valve: the PREDICT PVL study. Issue 2 (26th November 2020)

• Record Type: Journal Article
• Authors: Brinkert, Miriam; De Boeck, Bart; Stämpfli, Simon F; Wolfrum, Mathias; Moccetti, Federico; Attinger-Toller, Adrian; Bossard, Matthias; Cuculi, Florim; Kobza, Richard; Toggweiler, Stefan
• Is Part Of: Open heart. Volume 7:Issue 2(2020)
• Publication Date: 2020-11-26
• Subjects: aortic valve disease -- quality of care and outcomes -- transoesophageal; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Patients -- Periodicals; 616.12005
• DOI: 10.1136/openhrt-2020-001391
• Languages: English
• ISSNs: 2398-595X

Abstract

Abstract : Objectives: Report predictors and the natural course of paravalvular leak (PVL) following implantation of the ACURATE neo transcatheter heart valve (THV). Background: Understanding the mechanisms of PVL may help to improve patient selection, patient outcomes and the design of next-generation THVs. Methods: A total of 30 patients (mean age 81±5 years, 47% women) undergoing transcatheter aortic valve replacement with the ACURATE neo were enrolled in the PREDICT PVL study. The effective regurgitant orifice area (EROA, in mm 2 ) of PVL was assessed by transthoracic and transoesophageal echocardiography before discharge and at 6 months follow-up. Results: PVL was none/trace in 10 (33%), mild in 18 (60%) and moderate in 2 (7%) patients and occurred in distinct locations with largest EROAs in the area of the left coronary cusp and its adjacent commissures. Independent predictors for EROA were implantation depth (r coefficient −1.9 mm 2 per mm implantation depth, p=0.01), leaflet calcification (6.2 mm 2 per calcification grade, p=0.03) and THV size L (7.6 mm 2 more than size S or M, p=0.01). At 6 months follow-up, EROA decreased by 29% from 13.7±9.7 mm 2 to 9.5±7.9 mm 2 (p<0.01). Patients with smaller EROAs were more likely to be in New York Heart Association class 1 than patients with larger EROAs (p<0.01). Conclusions: PVL occurred predominantly in the region of the left coronary cusp and decreased by 29% during 6 months of follow-up. Our results underscore the importance of adequate patient selection and optimal implantation depth.