Prediction of paravalvular leakage after transcatheter aortic valve implantation

Abstract

Significant paravalvular leakage (PVL) after transcatheter aortic valve implantation (TAVI) is related to patient mortality. Predicting the development of PVL has focused on computed tomography (CT) derived variables but literature targeting CoreValve devices is limited, controversial, and did not make use of standardized echocardiographic methods. The study included 164 consecutive patients with severe aortic stenosis that underwent TAVI with a Medtronic CoreValve system©, with available pre-TAVI CT and pre-discharge transthoracic echocardiography. The predictive value for significant PVL of the CT-derived Agatston score, aortic annulus size and eccentricity, and "cover index" was assessed, according to both echocardiographic Valve Academic Research Consortium (VARC) criteria and angiographic Sellers criteria. Univariate predictors for more than mild PVL were the maximal diameter of the aortic annulus size (for both angiographic and echocardiographic assessment of PVL), cover index (for echocardiographic assessment of PVL only), and Agatston score (for both angiographic and echocardiographic assessment of PVL). The aortic annulus eccentricity index was not predicting PVL. At multivariate analysis, Agatston score was the only independent predictor for both angiographic and echocardiographic assessment of PVL. Agatston score is the only independent predictor of PVL regardless of the used imaging technique for the definition of PVL.

Keywords: Aortic valve; Computed tomography; Echocardiography; Paravalvular leakage; TAVI; Transcatheter.

Fig. 1

Distribution of VARC-2 scores according to the VARC-2 categories

Fig. 2

Correlation between angiographic Sellers grading and continuous value of VARC-2 scores for the assessment of paravalvular leakage

Fig. 3

Examples from two patients with low and high Agatston score, respectively and corresponding colour Doppler short-axis views of paravalvular leak on 2D echocardiography