Thorac Cardiovasc Surg 2013; 61 - SC29
DOI: 10.1055/s-0032-1332527

Trace to mild Paravalvular Regurgitation after Transcatheter Aortic Valve Implantation (TAVI): A multivariante analysis

ME Stelzmüller 1, K Mirschinka 1, B Mora 2, S Sandner 1, G Laufer 1, W Wisser 1
  • 1Medizinische Universität Wien, Herzchirurgie, Wien, Austria
  • 2Medizinische Universität Wien, Herzchirurgische Anästhesie und Intensivmedizin, Wien, Austria

Objective: Paravalvular regurgitation (PVR) after TAVI remains as a common problem. The aim of this study was to examine the correlation between the symmetry of aortic valve calcification (AVC), the calcium distribution and the prosthesis/annulus-congruence, on the prevalence of PVL.

Methods: 30 patients referred for TAVI routinely underwent DualScan-CT and TTE preoperatively. The calcium load was analyzed by using “Calcium Scoring” Software. Haemodynamic performance, the presents and location of Paravalvular leaks were evaluated by echocardiography. The cover index was calculated as a ratio of prosthesis diameter-annulus-size by prosthesis diameter.

Results: 44% of the selected patients showed asymmetric, 56% symmetric AVC. Trace to mild PVR was detected in 63% of patients. Neither symmetry nor the cover index was reliable to predict the prevalence or location of PVL. All patients with a general calcium load higher than 3000 mm3 or a calcium load of one cusp above 1500 mm3 exhibited PVR. PVLs persisting until 30 day follow up did not seal.

Conclusion: The aortic valve calcium load in general (> 3000 mm3) or alternatively of one cusp (> 1500 mm3) seems to play a significant role in development of PVLs, independent from the symmetry of AVC. The detailed genesis of trace or mild PVR remains unknown substantiating the need of further investigations.