Multidetector row computed tomography parameters associated with paravalvular regurgitation after transcatheter aortic valve implantation

Abstract

Multidetector row computed tomographic (MDCT) assessment of aortic annulus dimensions and frame position and deployment have been associated with paravalvular aortic regurgitation (PAVR) after transcatheter aortic valve implantation (TAVI). The present evaluation investigated the (pre- and postprocedure) MDCT associates of PAVR ≥2+. In total, 123 patients referred for TAVI underwent clinical evaluation, transthoracic echocardiography, and pre- and post-TAVI MDCT. Pre-TAVI MDCT measurements of the aortic annular dimensions and post-TAVI MDCT evaluation of the position and deployment of the prosthesis in the native annulus were performed. At 1-month follow-up, PAVR ≥2+ was observed in 25 patients (20%). The difference between the MDCT-derived maximum aortic annulus and the nominal diameters of the implanted prosthesis (odds ratio 1.912, p = 0.002) and shallow position of the frame in the left ventricular outflow tract (<2 mm) (odds ratio 4.865, p = 0.017) were independently related to significant PAVR. A maximum annulus diameter ≥2 mm larger than the nominal frame diameter had 72% sensitivity and 61% specificity to predict PAVR. In conclusion, in patients undergoing TAVI, ≥2-mm difference between maximum aortic annulus and nominal prosthesis diameters and depth of the frame into the left ventricular outflow tract of <2 mm are independently associated with PAVR ≥2+.