Nathalie Pirot, Presenter: Nothing to Disclose

Jerome Caudron MD, Abstract Co-Author: Nothing to Disclose

Clement De Vecchi, Abstract Co-Author: Nothing to Disclose

Valentin Lefebvre, Abstract Co-Author: Nothing to Disclose

Claire Werquin, Abstract Co-Author: Nothing to Disclose

Jean-Nicolas Dacher MD, PhD, Abstract Co-Author: Consultant, General Electric Company

Aortic regurgitation (AR) is frequent after transcatheter aortic valve implantation (TAVI) but predicting its occurrence remains difficult. The aim of this study was to determine, from pre-TAVI MSCT, the anatomical factors associated with significant AR after implantation.

Single-center study involving 40 patients with severe aortic stenosis who underwent thereafter a TAVI. A retrospectively ECG-gated MSCT (GE Discovery 750HD) was performed before TAVI and the following measurements were performed: minimal (Dmin) and maximal (Dmax) diameters, perimeter, and area of the aortic annulus; aortic root diameters at Valsalva, sino-tubular junction and tubular levels; planimetry of the aortic valve area; four-scale semi-quantitative calcium scoring of the native aortic valve using the Willmann score; maximal thickness of left, right and non-coronary cusps. MSCT data were compared to the occurrence of AR≥grade 2 on transthoracic echocardiography performed one month after TAVI.

Aortic regurgitation ≥grade 2 was found in 15/40 (37%) patients, with 14/15 (93%) grade 2 and 1/15 (7%) grade 3. Aortic regurgitation was paravalvular in 14/15 (93%) patents and centrovalvular in 1/15 (7%) patient. Patients with AR≥grade 2 had a largest annulus size when compared to patients with no or grade 1 AR: Dmin (23.6±2.8mm vs. 21.8±1.7mm,p=0.047), Dmax (29.0±2.4mm vs. 27.1±2.3mm, p=0.02), perimeter (85.4±7.3mm vs. 79.0±6.2mm, p=0.01), and area (5.4±0.9cm2 vs. 4.6±0.7cm2, p=0.01). They also had largest aortic root diameters at sinus (34.2±2.5mm vs. 31.2±3.0mm, p=0.002) and sino-tubular-junction levels (31.5±3.5mm vs. 27.9±2.3mm, p=0.002). Patients with AR≥grade 2 were more often implanted with 26mm valve size (11/15, 73%) than patients with no or grade 1 AR (12/25, 48%) (p=0.19). Native aortic valve calcifications were more pronounced in patients with AR≥grade 2 (14/15 grade 4, 1/15 grade 3) than in patients with no or grade 1 AR (17/25 grade 4, 8/15 grade 3) (p=0.14).

Paravalvular AR≥grade 2 is frequent after TAVI and associated with largest aortic root dimensions and more pronounced calcifications of the native aortic valve on MSCT performed before implantation.

This study support the use of MSCT for correct annulus sizing and calcification assessment before TAVI, and confirms the interest of the newly designed 29mm valve size in patients with largest annulus

Pirot, N, Caudron, J, De Vecchi, C, Lefebvre, V, Werquin, C, Dacher, J, Cardiac MSCT before Transcatheter Aortic Valve Implantation with the Edwards SAPIEN Bioprosthesis: Anatomical Factors Predicting Aortic Regurgitation after Implantation.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11009164.html