Optimal Sizing for Sapien 3 Transcatheter Aortic Valve Replacement in Patients With or Without Left Ventricular Outflow Tract Calcification.

Research paper by Yoshio Y Maeno, Yigal Y Abramowitz, Hasan H Jilaihawi, Sharjeel S Israr, Sunghan S Yoon, Rahul P RP Sharma, Yoshio Y Kazuno, Hiroyuki H Kawamori, Masaki M Miyasaka, Tanya T Rami, Geeteshwar G Mangat, Nobuyuki N Takahashi, Kazuaki K Okuyama, Mohammad M Kashif, Tarun T Chakravarty, et al.

Indexed on: 25 Jan '17Published on: 25 Jan '17Published in: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology

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Abstract

The impact of left ventricular outflow tract calcification (LVOT-CA) on Sapien 3 transcatheter aortic valve replacement (S3-TAVR) is not well understood. The aims of the present study were to determine optimal device sizing for S3-TAVR in patients with or without LVOT-CA and to evaluate the influence of residual paravalvular leak (PVL) on survival after S3-TAVR in these patients.This study analyzed 280 patients (LVOT-CA=144, no LVOT-CA=136) undergoing S3-TAVR. Optimal annular area sizing was defined as % annular area sizing related to lower rates of ≥ mild PVL. Annular area sizing was determined as follows: (prosthesis area/CT annulus area-1) x100. Overall, ≥ mild PVL was present in 25.7%. Receiver operator characteristic curve analysis for prediction of ≥ mild PVL in patients with LVOT-CA showed that 7.2% annular area sizing was identified as the optimal threshold [area under the curve (AUC) 0.71]. Conversely, annular area sizing for no LVOT-CA appeared unrelated to PVL (AUC 0.58). Aortic annular injury was seen in four patients (average 15.5% annular area over-sizing), three of whom had LVOT-CA. Although there was no difference in 1-year survival between patients with ≥ mild PVL and without PVL (log-rank p=0.91), subgroup-analysis demonstrated that patients with ≥ moderate LVOT-CA who had ≥ mild PVL had lower survival compared to patients with ≥ mild PVL and none or mild LVOT-CA (log-rank p=0.010).In the setting of LVOT-CA, optimally-sized S3valve is required to reduce PVL and to increase survival following TAVR.

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