Effect of concomitant aortic regurgitation on early hypo‐attenuated leaflet thickening after transcatheter aortic valve replacement in patients with symptomatic severe aortic stenosis

Objective We hypothesize that different degree of pre‐existing aortic regurgitation (AR) may affect the presence of hypo‐attenuated leaflet thickening (HALT) after transcatheter aortic valve replacement (TAVR). Background The mechanism of the presence of HALT post‐TAVR is not fully understood. Methods We retrospectively evaluated the post‐procedural multi‐slice computed tomography (MSCT) before discharge for evidence of HALT. Patients were grouped according to the degree of pre‐existing AR. Baseline, native anatomy and procedure details were compared, then multivariate regression was performed. Results MSCT analyzed was performed at a median of 6 days post‐TAVR in 179 patients. HALT was detected in 10.6% of patients. After adjusting for variables that were significantly different between groups, pre‐existing ≥ moderate AR was protective to the risk of HALT (OR 0.15, 95% CI 0.03–0.84, p = .03). Stratifying for factors that might explain the impact of pre‐existing AR on HALT, patients with a small Sinus of Valsalva, non‐eccentric remodeling and receiving a large bioprosthesis experienced a sevenfold higher risk for HALT (OR 7.16, 95% CI 2.05–25.08, p = .002). Conclusions Patients underwent TAVR with pre‐existing ≥ moderate AR appeared to experience a lower incidence of early HALT compared to those patients with less than moderate AR, which may be explained by a larger Sinus of Valsalva and a higher proportion of LV eccentric remodeling.