What is the clinical evidence from this study?

Study design: Observational. Population: Severe aortic stenosis (n=100). Intervention: Transcatheter aortic valve implantation (TAVI) vs. Less than moderate paravalvular leak. Primary outcome: Mean area of the aortic annulus (p=0.02).

September 27, 2021Open Access

Computed tomography assessment of the aortic root morphology in predicting the development of paravalvular leak following transcatheter aortic valve implantation

Key Result

Patients with at least moderate paravalvular leak after transcatheter aortic valve implantation had a significantly greater mean area of the aortic annulus (5.2 cm2 vs 4.7 cm2) compared to those with less than moderate leak.

Study Design

Type

Observational (n=100)

Multicenter

Structured PICO

Does pre-procedural MSCT assessment of aortic root morphology predict the development of paravalvular leak following TAVI in patients with severe aortic stenosis?

Population

100 consecutive patients with severe aortic stenosis (50 with bicuspid and 50 with tricuspid aortic valve) at high surgical risk undergoing transcatheter aortic valve implantation, mean age 76.5 years, 50% female.

Intervention

Transcatheter aortic valve implantation (TAVI) with pre-procedural multislice computed tomography (MSCT) assessment of aortic root morphology.

Outcome

Severity of paravalvular leak (PVL) assessed by transthoracic echocardiography at mean 7.6 days after TAVI.surrogate

Pre-procedural MSCT assessment of aortic root morphology, particularly LVOT size and the presence of a bicuspid aortic valve, can help predict the risk of moderate or worse paravalvular leak after TAVI.

Main Result

Absolute Event Rate: 5.2% vs 4.7%

p-value: p=0.02

Limitations

This was a single-center study.
Small sample size.
The study included only patients at high surgical risk and the complications may be associated with their general health.
A longer follow-up is needed to validate the outcomes.

Abstract

Introduction: Transcatheter aortic valve implantation (TAVI) is an effective treatment of significant aortic stenosis. Paravalvular leaks (PVLs) are one of the most common complications after the procedure. Objectives: The aim of this study was to assess whether the aortic root morphology affects the occurrence of PVL after TAVI. Patients and methods: We enrolled 50 patients with bicuspid and 50 patients with tricuspid aortic valve who underwent multislice computed tomography (MSCT) and transthoracic echocardiography prior to TAVI. The dimensions of the aortic root were assessed by MSCT. PVL after TAVI was assessed by transthoracic echocardiography. Patients were divided in 2 groups according to the PVL severity: less than moderate PVL (n = 80) and moderate or worse PVL (n = 20), and comparisons between the groups were performed. Results: Patients with at least moderate PVL, compared with those with less than moderate PVL, had greater mean (SD) area (5.2 1.1 cm2 vs 4.7 0.8 cm2; P = 0.02), perimeter (8.4 0.9 cm vs 7.9 0.7 cm; P = 0.01), and long axis (29.5 2.7 mm vs 28 2.7 mm; P = 0.04) of the aortic annulus and greater mean (SD) area (5.3 1.3 cm2 vs 4.7 1.1 cm2; P = 0.04) and perimeter (8.6 1.1 cm vs 8.1 0.9 cm; P = 0.02) of the left ventricular outflow tract. In multivariable analysis, bicuspid aortic valve disease, interventricular septum hypertrophy, greater left ventricular outflow tract, and postdilatation were significant predictors of moderate PVL following TAVI. Conclusions: The assessment of the aortic root morphology with MSCT can be helpful in predicting PVL after TAVI.

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