Incidence, Predictors, and Outcome of Paravalvular Leak after Transcatheter Aortic Valve Implantation

Abstract

Background. Paravalvular leak (PVL) is common after transcatheter aortic valve implantation (TAVI) and has been linked with worse survival. This study aimed to investigate the determinants and outcome of PVL after TAVI and determine the role of aortic valve calcification (AVC) distribution in predicting PVL. Methods and Results. This was a retrospective cohort study of 270 consecutive patients who underwent TAVI. Determinants and outcomes of ≥mild PVL were assessed. Matching rates of PVL jet with AVC distribution were calculated. AVC volume, larger annulus dimensions, and transvalvular peak velocity were risk factors for ≥mild PVL after TAVI. AVC volume was an independent predictor of ≥mild PVL. On the other hand, annulus ellipticity, left ventricular outflow tract nontubularity, and diameter-derived prosthesis mismatch were not found to predict PVL after TAVI. PVL jet matched, in varying proportions, with calcification at all aortic root regions, and the highest matching rate was with calcifications at body of leaflets. Moreover, matching rates were less with commissure compared to cusp calcifications. Mild or greater PVL was not associated with all-cause and cardiovascular mortality up to 1-year follow-up. Conclusion. ≥mild PVL after TAVI is common and can be predicted by aortic root calcification volume, larger annulus dimensions, and pre-TAVI transvalvular peak velocity, with calcification volume being an independent predictor for PVL. However, annulus ellipticity, left ventricular outflow tract nontubularity, and diameter-derived prosthesis mismatch had no role in predicting PVL. Importantly, body of leaflet calcifications (versus annulus and tip of leaflet) and cusp calcifications (versus commissure calcification) are more important in predicting PVL. No association between ≥mild PVL and increased risk of all-cause and cardiovascular mortality at 1-year follow-up.

Impact of membranous septum length on pacemaker need with different transcatheter aortic valve replacement systems: The INTERSECT registry

“…13,14 Anatomy tailored THV selection in the presence of a short MS may help mitigate need for PPI after TAVR but should also take into consideration risks for THV underexpansion, prosthesis patient mismatch and paravalvular leaks that may impact clinical outcome after TAVR. [15][16][17]…”

Surgical versus transcatheter aortic valve replacement in low‐risk patients: A long‐term propensity score‐matched analysis

“…Several risk factors for the need of PPM have been identified, 10 such as preexisting conduction disease, calcification of the aortic or mitral valve annulus, valve implantation depth, balloon post‐dilatation, and using a self‐expandable valve. More than mild PVL has been related mainly to the same predictive factors 11 . In our population, a self‐expandable valve was used in 62% of the matched TAVI patients, which might partially explain why our PPM and PVL rates were in line with the Evolut Low Risk and the NOTION trials, which used a self‐expandable valve for all procedures.…”

Implantation depth and its influence on complications after TAVI with self-expanding valves

“…This could be explained by the fact that the mean implantation depth in our study was higher and more following the manufactures recommendation than in the above study (4.3 ± 3.0 mm vs. 6.2 ± 2.9 mm). According to previous publications, a higher calcification grade of the device landing zone is associated with a more pronounced PVL [ 16 , 17 ].…”