Aortic root calcification volume independently predicted ≥mild paravalvular leak after TAVI, but ≥mild PVL was not associated with increased all-cause or cardiovascular mortality at 1-year follow-up.
Cohort (n=270)
What are the predictors of paravalvular leak after TAVI and does ≥mild paravalvular leak affect 1-year mortality?
Aortic valve calcification volume predicts paravalvular leak after TAVI, though mild or greater PVL did not impact 1-year mortality in this cohort.
BACKGROUND: Paravalvular leak (PVL) is common after transcatheter aortic valve implantation (TAVI) and has been linked with worse survival. This study aimed to investigate the determinants and outcome of PVL after TAVI and determine the role of aortic valve calcification (AVC) distribution in predicting PVL. METHODS AND RESULTS: This was a retrospective cohort study of 270 consecutive patients who underwent TAVI. Determinants and outcomes of ≥mild PVL were assessed. Matching rates of PVL jet with AVC distribution were calculated. AVC volume, larger annulus dimensions, and transvalvular peak velocity were risk factors for ≥mild PVL after TAVI. AVC volume was an independent predictor of ≥mild PVL. On the other hand, annulus ellipticity, left ventricular outflow tract nontubularity, and diameter-derived prosthesis mismatch were not found to predict PVL after TAVI. PVL jet matched, in varying proportions, with calcification at all aortic root regions, and the highest matching rate was with calcifications at body of leaflets. Moreover, matching rates were less with commissure compared to cusp calcifications. Mild or greater PVL was not associated with all-cause and cardiovascular mortality up to 1-year follow-up. CONCLUSION: ≥mild PVL after TAVI is common and can be predicted by aortic root calcification volume, larger annulus dimensions, and pre-TAVI transvalvular peak velocity, with calcification volume being an independent predictor for PVL. However, annulus ellipticity, left ventricular outflow tract nontubularity, and diameter-derived prosthesis mismatch had no role in predicting PVL. Importantly, body of leaflet calcifications (versus annulus and tip of leaflet) and cusp calcifications (versus commissure calcification) are more important in predicting PVL. No association between ≥mild PVL and increased risk of all-cause and cardiovascular mortality at 1-year follow-up.
Hagar et al. (2020) conducted a cohort in Paravalvular leak after transcatheter aortic valve implantation (n=270). Aortic valve calcification (AVC) volume and distribution was evaluated on ≥mild paravalvular leak (PVL) and all-cause or cardiovascular mortality. Aortic root calcification volume independently predicted ≥mild paravalvular leak after TAVI, but ≥mild PVL was not associated with increased all-cause or cardiovascular mortality at 1-year follow-up.