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Can we predict postprocedural paravalvular leak after E dwards SAPIEN transcatheter aortic valve implantation?
Author(s) -
Watanabe Yusuke,
Lefèvre Thierry,
Arai Takahide,
Hayashida Kentaro,
Bouvier Erik,
Hovasse Thomas,
Romano Mauro,
Chevalier Bernard,
Garot Philippe,
DonzeauGouge Patrick,
Farge Arnaud,
Cormier Bertrand,
Morice MarieClaude
Publication year - 2015
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25665
Subject(s) - medicine , odds ratio , confidence interval , cardiology , aortic valve , calcification , receiver operating characteristic
Background 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. Methods and Results 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, P = 0.006) and the valve diameter/the calculated average annulus diameter (CAAD) by MDCT (OR = 0.683, 95% CI = 0.474–0.984, P = 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 3 /m 2 , and summing all points accrued. Area under receiver‐operator characteristic curves of PVL score was 0.71 (95% CI = 0.59–0.83, P < 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. Conclusions 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.