J Clin Med. 2020;9(12):jcm9123936.

Optimal Oversizing Index Depending on Valve Type and Leakage-Proof Function for Preventing Paravalvular Leakage after Transcatheter Aortic Valve Implantation.

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제1저자 기유정 · 교신저자 김효수

PMID 33291760 PMC7761987 DOI 10.3390/jcm9123936 IF 3.3 순환기내과

소속 (1)

Cardiovascular Center, Seoul National University Hospital, Seoul 03080, Korea.

Abstract

Paravalvular leak (PVL) is an important complication of transcatheter aortic valve implantation (TAVI) and is associated with poor prognosis. We aimed to identify the risk factors for PVL after TAVI including patient (calcium amount or location), device (leakage-proof or not), and procedural (oversizing index (OI)) factors. The primary outcome was mild or greater PVL at 1-month follow-up echocardiography. Overall, 238 patients who underwent TAVI using eight types of valves (Edwards Sapien, Sapien XT, Sapien 3, CoreValve, Evolut R, Evolut PRO, Lotus, and Lotus Edge) were included. The incidence of significant PVL (≥mild PVL) was 24.4%. Although patient factors (calcification of valve) were not predictors of PVL, valve without leakage-proof function (Edwards Sapien, Sapien XT, and CoreValve) was a significant predictor of PVL (adjusted odds ratio, 3.194, 95% CI, 1.620-6.299). Furthermore, OI has a significant protective role against PVL (PVL increased by 45% when OI decreased by 5%). The best cutoff value of OI to predict the absence of PVL was ≥17.6% for the Evolut system and ≥10.2% for the Sapien system. The predictors of PVL after TAVI included factors from the device (valve without leakage-proof function) and procedure (under-sizing). In patients with a high risk of PVL, the procedure should be optimized using valves with leakage-proof function and adequate OI.

Keywords

leakage-proof functionoversizing indexparavalvular leakagetranscatheter aortic valve implantation

Figures

**Figure 1** Flow diagram of participants. LCC, left coronary cusp; LVOT, left ventricular outflow tract; NCC, non-coronary cusp; PVL, paravalvular leakage; RCC, right coronary cusp; TAVI, transcatheter aortic valve implantation.

**Figure 2** Incidence of significant PVL in each prosthesis group assessed by 1-month follow-up echocardiography. (A) early generation versus new-generation valve; (B) self-expandable versus balloon/mechanically expandable valve; (C) valve without leakage-proof function versus valve with leakage-proof function; (D) in the five prosthesis groups. PVL, paravalvular leakage.

**Figure 3** Receiver operating characteristic curves of optimal oversizing index for prediction absence of paravalvular leakage in each type of TAVI valve. AUC, area under the curve; CI, confidence interval; COV, cut-off value; TAVI, transcatheter aortic valve implantation.

**Figure 4** Continuous relation between oversizing index and risk of PVL calculated by fractional polynomial regression. Gray shading indicates 95% confidence interval around the flat line. The OR was adjusted for the calcium amount. (A) valve with leakage-proof function; (B) valve with leakage-proof function. OR, odds ratio; PVL, paravalvular leakage.

그림 출처: PubMed Central 공개 논문 (PMC7761987)

Conflict of interest statement

The authors declare no conflict of interest.

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