Author + information
- Syed Zaid1,
- Gilbert Tang2,
- Samuel R. Schnittman3,
- Hasan Ahmad4,
- Ryan Kaple5,
- Tanya Dutta5,
- Angelica Poniros5,
- Joanne Bennett5,
- Cheng Feng5,
- Martin Cohen5 and
- Steven Lansman1
- 1Westchester Medical Center/New York Medical College, Valhalla, New York, United States
- 2Mount Sinai Health System, New York, New York, United States
- 3Icahn School of Medicine at Mount Sinai, New York, New York, United States
- 4Westchester Medical Center/New York Medical College, White Plains, New York, United States
- 5Westchester Medical Center, Valhalla, New York, United States
Annular sizing predicts paravalvular leak (PVL) and new persistent left bundle branch block (pLBBB), but little is known on Left Ventricular Outflow Tract (LVOT) anatomy on TAVR outcomes. We propse an LVOT seal zone to quantify LVOT-Annular mismatch and derive a “non-tubular index (NTI)”, to determine impact of LVOT on TAVR.
From 11/2014 to 3/2017, 193 patients underwent TAVR with Sapien 3 Valve (S3) or CoreValve (CV). The LVOT seal zone was defined as an elliptical frustum and LVOT-Annular mismatch was expressed by the absolute difference between Annulus (A1) and LVOT (A2) areas by CT corrected to the volume of frustum. NTI = [A1-A2]/[A1+A2+sqrt(A1xA2)] x 100% with a greater NTI corresponding to a more non-tubular LVOT (Figure). Mean NTI were compared 0/1+ (none/trace) PVL vs 2+ (mild) PVL groups on 30-day echo and no LBBB vs pLBBB groups in S3 and CV.
Baseline NTI were similar between S3 and CV. In CV, there were no differences in mean NTIs between the 0/1+ and 2+ PVL (p=0.52) and between no LBBB and pLBBB groups (p=0.80). In S3, greater NTI was associated with 2+ PVL (p=0.026) and pLBBB (p=0.024). NTI was independent predictor of pLBBB in S3 (OR 1.37 per % NTI, 95% CI 1.08-1.74, p=0.009).
Non-tubular LVOT is associated with mild PVL and pLBBB after S3 not CV TAVR. LVOT-Annular mismatch (greater NTI) creates a more heterogeneous and shorter seal zone against the S3 frame after circularization, resulting in more PVL and pLBBB. The CV self-expansion may conform better with non-tubular LVOT. A multicenter study is underway to further examine the significance of NTI in TAVR.
STRUCTURAL: Valvular Disease: Aortic