TY - JOUR
T1 - Anatomical risk models for paravalvular leak and landing zone complications for balloon-expandable transcatheter aortic valve replacement
AU - Condado, Jose F.
AU - Corrigan, Frank E.
AU - Lerakis, Stamatios
AU - Parastatidis, Ioannis
AU - Stillman, Arthur E.
AU - Binongo, Jose N.
AU - Stewart, James
AU - Mavromatis, Kreton
AU - Devireddy, Chandan
AU - Leshnower, Bradley
AU - Guyton, Robert
AU - Forcillo, Jessica
AU - Patel, Ateet
AU - Thourani, Vinod H.
AU - Block, Peter C.
AU - Babaliaros, Vasilis
N1 - Publisher Copyright:
© 2017 Wiley Periodicals, Inc.
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Background: Though several anatomical characteristics have been reported separately as risk factors for paravalvular leak (PVL) and landing zone (LZ) complications after transcatheter aortic valve replacement (TAVR), multivariate risk models are needed. Methods: Patients that underwent balloon-expandable TAVR with multidetector cardiac computed tomography (MDCT) sizing were studied. MDCT images were analyzed and the association between anatomical factors and ≥mild PVL, ≥moderate PVL, and LZ complications (annular rupture, requirement of new permanent pacemaker, and coronary obstruction) was determined, and subsequently competing predictive models were developed and validated. Results: A total of 316 consecutive TAVR patients were included. Median age was 82.0 years (74.0–87.0) and STS score was 8.3% (5.4–10.9). Factors associated with ≥mild PVL included TAVR with Sapien/Sapien XT vs. Sapien 3 (OR = 2.50, 95% CI = 1.24–5.07), LVOT nontubularity (OR = 1.02, 95% CI = 1.01–1.04), LZ calcification (OR = 1.01, 95% CI = 1.00–1.01), and low cover index (OR = 0.94, 95% CI = 0.91–0.96). Factors associated with LZ complications included LZ calcification (OR = 1.01, 95% CI 1.00–1.01), leaflet asymmetry (OR = 1.01, 95% CI 1.01–1.02), and cover index (OR = 1.09, 95% CI 1.03–1.14). Predictive models for ≥mild PVL (AUC = 0.71, 95% CI = 0.66–0.77), ≥moderate PVL (AUC = 0.75, 95% CI = 0.65–0.84), and LZ complications (AUC = 0.77, 95% CI = 0.67–0.87) were created using procedural details and anatomical data from the MDCT. Clinical variables were not included as they were poorly correlated with the occurrence of PVL and LZ complications. For each outcome, the area under the curve (AUC) of the multivariate model was superior to the model consisting only of individual factors. Conclusions: A model using procedural/anatomical characteristics derived from MDCT predicts ≥mild PVL, ≥moderate PVL, and LZ complications post-TAVR. Incorporation of anatomical risks into clinical practice may help stratify patients before TAVR.
AB - Background: Though several anatomical characteristics have been reported separately as risk factors for paravalvular leak (PVL) and landing zone (LZ) complications after transcatheter aortic valve replacement (TAVR), multivariate risk models are needed. Methods: Patients that underwent balloon-expandable TAVR with multidetector cardiac computed tomography (MDCT) sizing were studied. MDCT images were analyzed and the association between anatomical factors and ≥mild PVL, ≥moderate PVL, and LZ complications (annular rupture, requirement of new permanent pacemaker, and coronary obstruction) was determined, and subsequently competing predictive models were developed and validated. Results: A total of 316 consecutive TAVR patients were included. Median age was 82.0 years (74.0–87.0) and STS score was 8.3% (5.4–10.9). Factors associated with ≥mild PVL included TAVR with Sapien/Sapien XT vs. Sapien 3 (OR = 2.50, 95% CI = 1.24–5.07), LVOT nontubularity (OR = 1.02, 95% CI = 1.01–1.04), LZ calcification (OR = 1.01, 95% CI = 1.00–1.01), and low cover index (OR = 0.94, 95% CI = 0.91–0.96). Factors associated with LZ complications included LZ calcification (OR = 1.01, 95% CI 1.00–1.01), leaflet asymmetry (OR = 1.01, 95% CI 1.01–1.02), and cover index (OR = 1.09, 95% CI 1.03–1.14). Predictive models for ≥mild PVL (AUC = 0.71, 95% CI = 0.66–0.77), ≥moderate PVL (AUC = 0.75, 95% CI = 0.65–0.84), and LZ complications (AUC = 0.77, 95% CI = 0.67–0.87) were created using procedural details and anatomical data from the MDCT. Clinical variables were not included as they were poorly correlated with the occurrence of PVL and LZ complications. For each outcome, the area under the curve (AUC) of the multivariate model was superior to the model consisting only of individual factors. Conclusions: A model using procedural/anatomical characteristics derived from MDCT predicts ≥mild PVL, ≥moderate PVL, and LZ complications post-TAVR. Incorporation of anatomical risks into clinical practice may help stratify patients before TAVR.
KW - annular rupture
KW - annular sizing
KW - conduction disturbances
KW - paravalvular leak
KW - transcatheter aortic valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85018410651&partnerID=8YFLogxK
U2 - 10.1002/ccd.26987
DO - 10.1002/ccd.26987
M3 - Article
C2 - 28471092
AN - SCOPUS:85018410651
SN - 1522-1946
VL - 90
SP - 690
EP - 700
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 4
ER -