Predictors of Paravalvular Regurgitation after Transcatheter Aortic Valve Implantation for Aortic Stenosis using New Generation Balloon-Expandable SAPIEN 3

Abstract Paravalvular regurgitation (PVR) is a common and serious complication after transcatheter aortic valve implantation (TAVI). New generation balloon-expandable SAPIEN 3 has an outer sealing skirt to minimize PVR. However, the predictors of PVR after SAPIEN 3 transcatheter heart valve (THV) implantation have not been well investigated. We sought to clarify the determinants of PVR after TAVI using SAPIEN 3 with quantitative multidetector computed tomography (MDCT) assessment. This study analyzed 281 patients with severe symptomatic aortic stenosis who underwent TAVI using SAPIEN 3. Quantitative assessment of aortic root dimensions and calcium volume for leaflet, annulus, and left ventricular outflow tract (LVOT) were retrospectively performed with MDCT. MDCT nominal area oversizing was calculated using the following formula: % oversizing = (THV nominal area / MDCT derived annular area - 1) * 100. Logistic regression analysis was performed to determine the predictors of PVR ≥ mild. PVR ≥ mild was observed in 19% (53/281). Quantity and asymmetry of aortic valve calcium of annulus, LVOT, and leaflet were associated with higher incidence of PVR ≥ mild, except leaflet asymmetry. Lower percentage of THV oversizing was also associated with PVR. Multivariable logistic regression analysis showed that larger calcification volume of annulus and lower percentage of THV oversizing were independent predictors of PVR ≥ mild. These results suggest that as well as prosthesis/annulus incongruence, aortic annulus calcification predicted PVR ≥ mild after TAVI using SAPIEN 3.