Can we predict postprocedural paravalvular leak after Edwards SAPIEN transcatheter aortic valve implantation?

Yusuke Watanabe, Thierry Lefèvre, Takahide Arai, Kentaro Hayashida, Erik Bouvier, Thomas Hovasse, Mauro Romano, Bernard Chevalier, Philippe Garot, Patrick Donzeau-Gouge, Arnaud Farge, Bertrand Cormier, Marie Claude Morice

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background Postprocedural paravalvular leak (PVL)≥2 has been shown to be associated with worse outcomes after transcatheter aortic valve implantation (TAVI). This study sought to identify predictive factors of postprocedural PVL≥2 after TAVI with the Edwards valve. Methods and Results A total of 176 patients with Edwards TAVI (aged 83.4±7.4 years, Logistic EuroSCORE [the Logistic European System for Cardiac Operative Risk Evaluation] 18.8±12.0, transfemoral 54.5%) who had preprocedural multidetector computed tomography (MDCT) were studied. A PVL≥2 was observed in 12.5% of cases. By multivariate analysis, only the valve calcification index (VCI) defined as aortic root calcification volume/body surface area (odds ratio [OR]=1.002, 95% confidence interval [CI]=1.001-1.004, P=0.006) and the valve diameter/the calculated average annulus diameter (CAAD) by MDCT (OR=0.683, 95% CI=0.474-0.984, P=0.041) were identified as independent predictors of postprocedural PVL≥2. A score predicting postprocedural PVL≥2 (PVL score) was determined by allotting one point when the valve diameter/CAAD ratio was <1.055 and one point when VCI was >418.4 mm<sup>3</sup>/m<sup>2</sup>, and summing all points accrued. Area under receiver-operator characteristic curves of PVL score was 0.71 (95% CI=0.59-0.83, P<0.01). The incidence of PVL≥2 was 5.3% in patients with a PVL score of 0, 11.8% for a PVL score of 1 and 37.5% for a PVL score of 2. Conclusions The only predictors of PVL≥2 after Edwards valve implantation are the valve diameter/CAAD and VCI. The PVL score could prove to be an excellent tool for predicting the risk of PVL.

Original languageEnglish
Pages (from-to)144-151
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Volume86
Issue number1
DOIs
Publication statusPublished - 2015 Jul 1
Externally publishedYes

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Multidetector Computed Tomography
Confidence Intervals
Odds Ratio
Body Surface Area
Multivariate Analysis
Incidence
Transcatheter Aortic Valve Replacement

Keywords

  • aortic regurgitation
  • multidetector computed tomography
  • transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Can we predict postprocedural paravalvular leak after Edwards SAPIEN transcatheter aortic valve implantation? / Watanabe, Yusuke; Lefèvre, Thierry; Arai, Takahide; Hayashida, Kentaro; Bouvier, Erik; Hovasse, Thomas; Romano, Mauro; Chevalier, Bernard; Garot, Philippe; Donzeau-Gouge, Patrick; Farge, Arnaud; Cormier, Bertrand; Morice, Marie Claude.

In: Catheterization and Cardiovascular Interventions, Vol. 86, No. 1, 01.07.2015, p. 144-151.

Research output: Contribution to journalArticle

Watanabe, Y, Lefèvre, T, Arai, T, Hayashida, K, Bouvier, E, Hovasse, T, Romano, M, Chevalier, B, Garot, P, Donzeau-Gouge, P, Farge, A, Cormier, B & Morice, MC 2015, 'Can we predict postprocedural paravalvular leak after Edwards SAPIEN transcatheter aortic valve implantation?', Catheterization and Cardiovascular Interventions, vol. 86, no. 1, pp. 144-151. https://doi.org/10.1002/ccd.25665
Watanabe, Yusuke ; Lefèvre, Thierry ; Arai, Takahide ; Hayashida, Kentaro ; Bouvier, Erik ; Hovasse, Thomas ; Romano, Mauro ; Chevalier, Bernard ; Garot, Philippe ; Donzeau-Gouge, Patrick ; Farge, Arnaud ; Cormier, Bertrand ; Morice, Marie Claude. / Can we predict postprocedural paravalvular leak after Edwards SAPIEN transcatheter aortic valve implantation?. In: Catheterization and Cardiovascular Interventions. 2015 ; Vol. 86, No. 1. pp. 144-151.
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abstract = "Background Postprocedural paravalvular leak (PVL)≥2 has been shown to be associated with worse outcomes after transcatheter aortic valve implantation (TAVI). This study sought to identify predictive factors of postprocedural PVL≥2 after TAVI with the Edwards valve. Methods and Results A total of 176 patients with Edwards TAVI (aged 83.4±7.4 years, Logistic EuroSCORE [the Logistic European System for Cardiac Operative Risk Evaluation] 18.8±12.0, transfemoral 54.5{\%}) who had preprocedural multidetector computed tomography (MDCT) were studied. A PVL≥2 was observed in 12.5{\%} of cases. By multivariate analysis, only the valve calcification index (VCI) defined as aortic root calcification volume/body surface area (odds ratio [OR]=1.002, 95{\%} confidence interval [CI]=1.001-1.004, P=0.006) and the valve diameter/the calculated average annulus diameter (CAAD) by MDCT (OR=0.683, 95{\%} CI=0.474-0.984, P=0.041) were identified as independent predictors of postprocedural PVL≥2. A score predicting postprocedural PVL≥2 (PVL score) was determined by allotting one point when the valve diameter/CAAD ratio was <1.055 and one point when VCI was >418.4 mm3/m2, and summing all points accrued. Area under receiver-operator characteristic curves of PVL score was 0.71 (95{\%} CI=0.59-0.83, P<0.01). The incidence of PVL≥2 was 5.3{\%} in patients with a PVL score of 0, 11.8{\%} for a PVL score of 1 and 37.5{\%} for a PVL score of 2. Conclusions The only predictors of PVL≥2 after Edwards valve implantation are the valve diameter/CAAD and VCI. The PVL score could prove to be an excellent tool for predicting the risk of PVL.",
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AU - Watanabe, Yusuke

AU - Lefèvre, Thierry

AU - Arai, Takahide

AU - Hayashida, Kentaro

AU - Bouvier, Erik

AU - Hovasse, Thomas

AU - Romano, Mauro

AU - Chevalier, Bernard

AU - Garot, Philippe

AU - Donzeau-Gouge, Patrick

AU - Farge, Arnaud

AU - Cormier, Bertrand

AU - Morice, Marie Claude

PY - 2015/7/1

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N2 - Background Postprocedural paravalvular leak (PVL)≥2 has been shown to be associated with worse outcomes after transcatheter aortic valve implantation (TAVI). This study sought to identify predictive factors of postprocedural PVL≥2 after TAVI with the Edwards valve. Methods and Results A total of 176 patients with Edwards TAVI (aged 83.4±7.4 years, Logistic EuroSCORE [the Logistic European System for Cardiac Operative Risk Evaluation] 18.8±12.0, transfemoral 54.5%) who had preprocedural multidetector computed tomography (MDCT) were studied. A PVL≥2 was observed in 12.5% of cases. By multivariate analysis, only the valve calcification index (VCI) defined as aortic root calcification volume/body surface area (odds ratio [OR]=1.002, 95% confidence interval [CI]=1.001-1.004, P=0.006) and the valve diameter/the calculated average annulus diameter (CAAD) by MDCT (OR=0.683, 95% CI=0.474-0.984, P=0.041) were identified as independent predictors of postprocedural PVL≥2. A score predicting postprocedural PVL≥2 (PVL score) was determined by allotting one point when the valve diameter/CAAD ratio was <1.055 and one point when VCI was >418.4 mm3/m2, and summing all points accrued. Area under receiver-operator characteristic curves of PVL score was 0.71 (95% CI=0.59-0.83, P<0.01). The incidence of PVL≥2 was 5.3% in patients with a PVL score of 0, 11.8% for a PVL score of 1 and 37.5% for a PVL score of 2. Conclusions The only predictors of PVL≥2 after Edwards valve implantation are the valve diameter/CAAD and VCI. The PVL score could prove to be an excellent tool for predicting the risk of PVL.

AB - Background Postprocedural paravalvular leak (PVL)≥2 has been shown to be associated with worse outcomes after transcatheter aortic valve implantation (TAVI). This study sought to identify predictive factors of postprocedural PVL≥2 after TAVI with the Edwards valve. Methods and Results A total of 176 patients with Edwards TAVI (aged 83.4±7.4 years, Logistic EuroSCORE [the Logistic European System for Cardiac Operative Risk Evaluation] 18.8±12.0, transfemoral 54.5%) who had preprocedural multidetector computed tomography (MDCT) were studied. A PVL≥2 was observed in 12.5% of cases. By multivariate analysis, only the valve calcification index (VCI) defined as aortic root calcification volume/body surface area (odds ratio [OR]=1.002, 95% confidence interval [CI]=1.001-1.004, P=0.006) and the valve diameter/the calculated average annulus diameter (CAAD) by MDCT (OR=0.683, 95% CI=0.474-0.984, P=0.041) were identified as independent predictors of postprocedural PVL≥2. A score predicting postprocedural PVL≥2 (PVL score) was determined by allotting one point when the valve diameter/CAAD ratio was <1.055 and one point when VCI was >418.4 mm3/m2, and summing all points accrued. Area under receiver-operator characteristic curves of PVL score was 0.71 (95% CI=0.59-0.83, P<0.01). The incidence of PVL≥2 was 5.3% in patients with a PVL score of 0, 11.8% for a PVL score of 1 and 37.5% for a PVL score of 2. Conclusions The only predictors of PVL≥2 after Edwards valve implantation are the valve diameter/CAAD and VCI. The PVL score could prove to be an excellent tool for predicting the risk of PVL.

KW - aortic regurgitation

KW - multidetector computed tomography

KW - transcatheter aortic valve implantation

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