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In patients undergoing transcatheter aortic valve replacement (TAVR), residual aortic insufficiency (AI) is associated with higher mortality. We hypothesized that aortic annular deformation & calcification play a role. We sought to assess predictors of post–TAVR AI, using echo & multidetector computed tomography or (MDCT)
We included 55 high–risk severe aortic stenosis (AS) patients (mean age 80±11 years, 51% men) that underwent pre–TAVR echo & cine contrast MDCT of aortic root, followed by TAVR & post–TAVR echo. Clinical & echo parameters (pre & post–TAVR) were recorded. MDCT post–processing was performed by creating 50–phases. Annular area, annular deformation (maximum–minimum over cardiac cycle) & eccentricity (largest/smallest diameter during systole) were calculated (Figure a). Degree of commisural & annular calcification were graded semiquantitatively (scale I–III).
Pre–TAVR ejection fraction, AI, aortic valve area, peak & mean AS gradients (in mmHg) were 53±13 %, 1± 0.8,0.6±0.1 cm2, 79±24 & 46±14 respectively. The maximal, minimal annular area & annular deformity were 4.9±1, 4.5±1 & 0.4±0.1 (all in cm2). Eccentricity index was 1.2±0.1. Commisural & annular calcification scores were 2.1±0.6 & 1.7±0.7, respectively. More than trivial AI was present in 32 (58%) patients. On logistic regression, predictors of residual AI are shown in Figure b.
Residual post–TAVR AI is predicted by reduced aortic annular deformity & higher annular calcification
West, Room 2002
Monday, March 11, 2013, 8:30 a.m.–8:40 a.m.
Session Title: Transcatheter Aortic Valve Replacement (TAVR) II: Complications
Abstract Category: 49. TCT@ACC–i2: Aortic Valve Disease
Presentation Number: 2911–5
- 2013 American College of Cardiology Foundation