Calcification of the right and non-coronary commissure (OR 2.66; 95% CI 1.39-5.12) and pre-TAVI area cover index (OR 0.95) independently predicted significant paravalvular AR after TAVI.
Observational (n=135)
What are the intraoperative 2D and 3D transoesophageal echocardiographic predictors of significant paravalvular aortic regurgitation after TAVI in patients with severe symptomatic aortic stenosis?
Specific intraoperative TEE findings, including commissural calcification and lower area cover index, independently predict significant paravalvular aortic regurgitation immediately following TAVI.
Odds Ratio: 2.66 (95% CI 1.39–5.12)
p-value: p=0.001
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.
Gripari et al. (Sun,) conducted a observational in Severe symptomatic aortic stenosis (n=135). Calcification of the commissure between the right coronary and non-coronary cusps vs. Absence of calcification was evaluated on Significant paravalvular aortic regurgitation (AR≥2) post-TAVI (OR 2.66, 95% CI 1.39-5.12, p=0.001). Calcification of the right and non-coronary commissure (OR 2.66; 95% CI 1.39-5.12) and pre-TAVI area cover index (OR 0.95) independently predicted significant paravalvular AR after TAVI.
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