Predicting Perivalvular Leak Following Sapien 3 Implantation Using Virtual Valve‐Based Computed Tomography Imaging

BACKGROUND: This study aimed to evaluate the predictive ability of quantifying aortic valve calcification using a virtual valve (VV) on computed tomography (CT) imaging for perivalvular leak (PVL) following Sapien 3 transcatheter heart valve implantation. METHODS: A total of 126 patients who underwent Sapien 3 implantation were retrospectively analyzed. Patients with left ventricular outflow tract calcification or bicuspid valves were excluded. Multiplanar CT reconstructions of the aortic root with the VV in position were utilized to measure calcium volumes located outside the VV, inside the VV, and across the entire valve leaflet. PVL was quantitatively assessed via transthoracic echocardiography using the formula: %PVL = (jet length along valve curvature/total perimeter) × 100. Significant PVL was defined as %PVL > 10%. RESULTS: Calcium volumes outside the VV, inside the VV, and in the entire valve leaflets were significantly correlated with %PVL (r = 0.58, p < 0.0001; r = 0.38, p < 0.0001; r = 0.50, p < 0.0001, respectively). Receiver operating characteristic (ROC) curve analysis identified optimal cutoff values for predicting significant PVL: calcium volume outside the VV ≥ 336.9 mm³ (area under the curve [AUC] 0.82, sensitivity 100%, specificity 59.3%), inside the VV ≥ 2502.1 mm³ (AUC 0.68, sensitivity 45.0%, specificity 90.7%), and in the entire valve leaflets ≥ 3268.2 mm³ (AUC 0.74, sensitivity 45.0%, specificity 94.2%). Among these, calcium volume outside the VV demonstrated the highest AUC. CONCLUSIONS: Quantifying calcium volume using VV on CT imaging is a valuable tool for accurately predicting significant PVL after Sapien 3 implantation.