OR3-2 | A Retrospective Analysis Assessing Paravalvular Leak Using a Strategy of TEE and Non-Contrast CT in CKD Patients versus CT Angiography For Annular Sizing Pre-TAVR

Transcatheter aortic valve replacement (TAVR) has become a safe and effective alternative to surgical valve replacement for patients with severe aortic stenosis. To minimize complications such as paravalvular leak (PVL) post-TAVR, accurate pre-procedural assessment of the aortic annulus and access vessels is essential. However, the use of contrast-enhanced computed tomography (CT) in patients with chronic kidney disease (CKD) is controversial. This study aimed to compare incidence of PVL after TAVR using CT angiography (CTA) for annular sizing in patients with normal kidney function and transesophageal echocardiogram (TEE) and CT without contrast in patients with CKD. In this retrospective cohort study, we evaluated 557 patients who underwent TAVR with the Edwards Sapien 3 valve between 2016-2021 at a tertiary-care hospital in Los Angeles. Patients with end-stage renal disease on hemodialysis were excluded from our analysis (n=29). A glomerular filtration rate (GFR) cutoff of 40 was used to determine imaging method. Post-procedural echocardiograms at hospital discharge, 30 days, and 1 year were used to quantify PVL severity. Patients lost to follow-up or deceased were included in the analysis until the time they were lost to follow-up or time of death. The primary outcome was incidence of PVL, analyzed using Fisher's exact test at a 95% confidence level. At 1 year, 23% of the TEE group (n=83) and 20% of the CTA group (n=445) had greater than trace PVL (p=0.61). There was no significant difference in PVL at discharge, 30 days, or 1 year between the TEE and CTA groups (17% vs. 12%, p=0.21; 21% vs. 20%, p=0.75; 23% vs. 20%, p=0.61). In both groups, the majority of PVL greater than trace was mild; the incidence of PVL greater than mild was low (4% in CTA group, 6.5% in TEE group at 1 year, p=0.33). Utilizing TEE and CT without contrast for pre-procedural annular sizing in patients with GFR less than 40 does not appear to increase risk of clinically significant PVL at up to 1 year post-TAVR compared to CTA. These findings may help guide imaging choices in TAVR patients with CKD.