Key result
Right-to-non-coronary commissural calcification linked to ~2.7-fold higher risk of significant post-TAVI paravalvular regurgitation.
Why the study?
Does intraoperative echocardiographic assessment of aortic valve calcification and area cover index predict significant post-procedural paravalvular aortic regurgitation in patients undergoing TAVI?
Cohort (n=135)
Yes
Does intraoperative echocardiographic assessment of aortic valve calcification and area cover index predict significant post-procedural paravalvular aortic regurgitation in patients undergoing TAVI?
Intraoperative 3D transesophageal echocardiography can accurately size the aortic annulus and evaluate commissural calcifications, aiding in prosthesis sizing to minimize paravalvular regurgitation during TAVI.
BACKGROUND: Post-procedural aortic regurgitation (AR) has been described in a large number of patients receiving transcatheter aortic valve implantation (TAVI). OBJECTIVE: The aim of this study was to examine the intraoperative 2-dimensional (2D) and 3-dimensional (3D) echocardiographic features of the aortic valve associated with significant post-procedural paravalvular AR. METHODS: A total of 135 patients (81±7 years) with severe symptomatic aortic stenosis, who underwent TAVI, were imaged with comprehensive 2D and 3D transoesophageal echocardiography before the procedure and peri-procedure. Various baseline and peri-procedural echocardiographic characteristics were tested to predict paravalvular AR post-TAVI: calcifications at the aortic valve commissures and leaflets, 'aortic annulus eccentricity index', 'area cover index', overlap between aortic prosthesis and anterior mitral leaflet. Post-procedural paravalvular AR≥2 was considered significant. RESULTS: Successful TAVI was achieved in all patients. The incidence of paravalvular AR≥2 immediately after the procedure was 21% (28 patients). Commissural calcifications and, particularly, the calcification of the commissure between the right coronary and non-coronary cusps was significantly more frequent in presence of paravalvular AR; the area cover index pre-TAVI was significantly lower among patients with AR (11.1±11.8% vs 20.8±12.5%, p=0.0004). Multivariate analysis revealed that calcification of the commissure between the right coronary and non-coronary cusps (OR=2.66, 95% CI 1.39 to 5.12, p=0.001), and the area cover index pre-TAVI (OR=0.95, 95% CI 0.91 to 0.99, p=0.006) were the only independent predictors of significant paravalvular AR after TAVI. CONCLUSIONS: Intraoperative 2D and 3D transoesophageal echocardiography identified calcification of the commissure between the right coronary and non-coronary cusps and the area cover index as independent predictors of significant paravalvular AR following TAVI.
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Gripari et al. (2012) conducted a cohort in Severe symptomatic aortic stenosis (n=135). Calcification of the commissure between the right coronary and non-coronary cusps vs. Absence of calcification in this commissure was evaluated on Significant post-procedural paravalvular aortic regurgitation (grade ≥2) (OR 2.66, 95% CI 1.39-5.12, p=0.001). Calcification of the commissure between the right coronary and non-coronary cusps increased the risk of significant paravalvular aortic regurgitation (OR 2.66) following transcatheter aortic valve implantation.
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