Optimal positioning of self-expanding valves before deployment decreases paravalvular regurgitation following transcatheter aortic valve replacement

Razvan T. Dadu, Jiaqiong Xu, Hasan Rehman, Moritz Wyler von Ballmoos, Colin M. Barker, Manuel Reyes, Mahesh Ramchandani, Ross M. Reul, Michael J. Reardon, Neal S. Kleiman

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objectives: To evaluate the association between measurements performed during Medtronic CoreValve (MCV) deployment and paravalvular leak (PVL). Background: The MCV can be recaptured and repositioned, allowing the TAVR operator to implant at a more favorable position. The association between angiographic measurements of MCV position while the valve is recapturable and PVL post deployment has not been investigated. Methods: 493 patients undergoing TAVR with MCV (January 2011–July 2017) were included. PVL was defined as intraprocedural aortic regurgitation that was judged clinically to require balloon postdilation. Depth of the valve at the left coronary cusp (LCC) and noncoronary cusp (NCC) were measured when the valve was 80% deployed. An optimal cutoff value for the ratio LCC/NCC for PVL was identified in 40 patients. Using this cutoff value, the association between LCC/NCC and PVL was then validated in 453 patients. Results: The median LCC/NCC was 1.51 (interquartile range 1.06–1.89).The optimal cutoff value for LCC/NCC was 1.48 (93% sensitivity, 77% specificity, AUC0.85). In the validation group 112 (24.7%) patients had PVL. For LCC/NCC ≥ 1.48, the incidence of PVL was lower compared to LCC/NCC < 1.48 (9.58% vs. 41.78%, P < 0.0001). LCC/NCC of 1.48 had a sensitivity of 79.5% and specificity of 63.6% for PVL (AUC0.72). In a multivariate model, LCC/NCC < 1.48 independently predicted PVL (OR = 6.67, 95% CI 3.96–11.23, P < 0.0001). Conclusion: Positioning the MCV such that the LCC/NCC is ≥1.48 may result in less PVL.

Original languageEnglish (US)
Pages (from-to)149-155
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume93
Issue number1
DOIs
StateAccepted/In press - Jan 1 2018

Keywords

  • aortic stenosis
  • core valve
  • medtronic
  • paravalvular aortic regurgitation
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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