Fabian Plank, Abstract Co-Author: Nothing to Disclose

Nikolaos Bonaros, Abstract Co-Author: Nothing to Disclose

Guy J. Friedrich MD, Abstract Co-Author: Nothing to Disclose

Thomas Bartel MD, Abstract Co-Author: Nothing to Disclose

Silvana Müller, Abstract Co-Author: Nothing to Disclose

Gudrun Feuchtner MD, Presenter: Nothing to Disclose

Moderate-to-severe paravalvular leaks after transcatheter aortic valve implantation (TAVI) are seen in about 12.2% and related to adverse outcome. Recent data indictate, that even mild leaks may affect outcome negatively. The nature and pathomechanism of leaks is not fully understood. To assess whether aortic annulus sizing by 3-D computed tomography angiography (CTA) is associated with paravalvular leaks after TAVI.

69 patients (mean age, 83 years) with severe aortic stenosis underwent TAVI for an IRB approved study. Prior transesophageal echocardiography (TEE) for annulus sizing, and aortoiliac-cardiac ECG-gated CT-Angiography was performed. The prosthetic heart valve (PHV) was selected based on TEE diameter. Three-annulus diameters (RC/LC/NC), two annulus diameter (ML/AP) and the annulus area were measured by CT. “Undersizing” was defined as: CT – effective PHV size. “Annulus eccentricity” was defined as the AP/ML-ratio. Post-operative echocardiography was performed and paravalvular leaks graded after the procedure, and after 1, 3-6, 12 and 24 months.

Of 69 implanted prosthetic heart valves 21(30%) had none, 32(46%) mild (AR grade 1), 8(12%) mild-to-moderate, 5(7%) moderate, 3(4%) moderate-to-severe, and 0% severe leaks. There was no intraprocedural death. TEE measured smaller mean annulus diameters than the mean of 3-diameters by CT (mean:-2,58mm, p= AR grade 1). “Undersizing” was higher in those with leaks as compared to those without (1.4mm vs 0.4mm, p=0.01), when using the three-diameter measurement; but no difference in undersizing between mild and moderate-to-severe (1.4mm vs. 1.2mm, p=0.57) leaks was found. The annulus area by CT was higher as compared to the nominal PHV area in patients with leaks than those without (1.12cm² vs. 0.5cm², p=0.04). Similarly, the annulus eccentricity index was higher (0.83 vs.0.79, p=0.01)

Effective prosthetic heart valve undersizing relative to CT aortic annulus dimensions, and annulus eccentricity are associated with paravalvular leaks after TAVI. For increasing leak severity, other factors than undersizing may be contributing.

Selection of prosthetic heart valve size integrating 3D-aortic annulus dimension measurement by CTA is useful to avoid paravalvular leaks caused by untersizing of the prosthesis based on TEE.

Plank, F, Bonaros, N, Friedrich, G, Bartel, T, Müller, S, Feuchtner, G, The Effect of Annulus Dimensions by Computed Tomography Angiography on Paravalvular Leaks after Transcatheter Aortic Valve Implantation (TAVI).  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12043758.html