Anatomical Predictors of Valve Malposition During Self-Expandable Transcatheter Aortic Valve Replacement

Frontiers in Cardiovascular Medicine

article

Jie Li¹  Yinghao Sun¹  Shengneng Zheng¹  Guang Li¹  Haojian Dong¹  Ming Fu¹  Yujing Mo¹  Yi Li²  Huadong Liu³  Zhaoyan Xu⁴  Liting Zhang⁵  Yong Cao⁶  Ruixin Fan¹  D. Scott Lim⁷  Jianfang Luo¹ 

[1] Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences;The First Affiliated Hospital of Sun Yat-sen University;Shenzhen People's Hospital;The First People Hospital of Foshan;Zhongshan City People's Hospital;Gaozhou People's Hospital;University of Virginia Health System Hospital

关键词: computed tomography;    malposition;    predictor;    self-expandable;    transcatheter aortic valve replacement;   

DOI  :  10.3389/fcvm.2021.600356

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Background: The consequence of valve malposition (VM) during transcatheter aortic valve replacement (TAVR) can be severe, but the determinants of VM with self-expandable TAVR have not been thoroughly evaluated. We aimed to investigate the anatomical predictors of VM during self-expandable TAVR. Methods: In this multicenter retrospective study, TAVR was performed using the Venus A-Valve. The baseline, computed tomography, and procedural characteristics along with clinical outcomes were collected. Multivariate logistic regression model and receiver operating characteristic (ROC) curve analyses were performed. Results: A total of 84 consecutive patients (23 with VM) were included. Stepwise regression showed that annulus perimeter/left ventricular outflow tract perimeter (AL ratio) and sinotubular junction (STJ) height were predictors of VM. The ROC curve indicated a moderate strength of AL ratio [area under the curve (AUC) 0.71, cutoff 0.96] and a weak strength of STJ height (AUC 0.69, cutoff 23.8 mm) to predict VM. The combination of both predictors revealed a higher predictive value of VM (AUC 0.77). In multivariate analysis, AL ratio <0.96 [odds ratio (OR) 3.98, p = 0.015] and STJ height ≥23.8 mm (OR 4.63, p = 0.008) were strong independent predictors of VM. The presence of both predictors was associated with a very high risk of VM (OR 10.67, p = 0.002). The rate of moderate-to-severe paravalvular regurgitation was higher in patients with VM at 30 days (26.1 vs. 4.9%, p = 0.011). Conclusions: A conical left ventricular outflow tract and tall aortic sinuses were strong anatomical predictors of VM during self-expandable TAVR.

【 授权许可】

CC BY