Association between deployment depth eccentricity index and hypo-attenuated leaflet thickening after transcatheter aortic valve replacement

Abstract Background Hypo-attenuated leaflet thickening (HALT) after transcatheter aortic valve replacement (TAVR) can lead to bioprosthetic valve dysfunction and reduced prosthesis durability, posing a potential threat to patients' long-term outcomes. Current evidence suggests that the geometric configuration of transcatheter heart valves (THV) may promote HALT by altering hemodynamic patterns within the aortic root. While existing research predominantly focuse on horizontal deformation of THV, and systematic investigations into longitudinal deformation in self-expanding valve cohorts remain critically underexplored. Purpose This study aims to explore the influence of the canting of THV on the occurrence of HALT. Methods We prospectively collected the data of 78 patients who underwent TAVR and were followed up for 6 months The deployment depth eccentricity index (DDEI) was used to quantify the canting of THV, which was calculated as maximum minus minimum implantation depth. We compared the difference of DDEI between patients with HALT and other patients, and verified its effect in different characteristic subgroups. Results All patients were implanted with self expanding valves and the incidence of HALT was 33.3% at 30 days after TAVR.Multivariate logistic regression identified DDEI (OR = 3.94, 95% CI: 2.08~7.44, P 0.001) as independent HALT risk factor. Receiver operating characteristic analysis demonstrated DDEI achieving an AUC of 0.896 (95% CI: 0.819~0.974). Subgroup analysis confirmed that the elevated risk of HALT associated with increased DDEI remained independent of anticoagulation, gender, valve type, and aortic regurgitation. At 6-month follow-up, patients with HALT demonstrated significantly higher incidence rates of stroke/transient ischemic attack (17.4% vs. 0%, P=0.018) and elevated PGmean (18.9 ± 10.1 mmHg vs. 14.2 ± 7.5 mmHg, P = 0.038). HALT was associated with significant post-discharge elevations in PGmean (18.9 ± 10.1 mmHg vs. 12.1 ± 3.2 mmHg, P = 0.015) and peak transvalvular flow velocity (270.5 ± 72.5 cm/s vs. 231.2 ± 32.5 cm/s, P = 0.023). Conclusion Excessive canting and oversizing of THV significantly elevate the risk of HALT after TAVR, which was closely related to hemodynamic deterioration.We found that optimizing the coaxiality and size selection of THV has important clinical significance for improving the prognosis of TAVR. Subsequently, we will strengthen the research in this direction and further verify it in a larger sample.Multivariable analysis for DDEI Effect of DDEI in subgroups