Clinical utility of a predictive model for paravalvular aortic regurgitation after transcatheter aortic valve implantation with a self-expandable prosthesis

Background

A predictive model for Paravalvular aortic regurgitation (PAR) integrating the left ventricular outflow tract-to-ascending aorta angle (LVOT-AO) and depth to the non-coronary cusp (NCC) after TAVI with CoreValve prosthesis (MCP) was retrospectively identified (2 × ∠LVOT-AO + [depth to NCC-10]2; cutoff = 50). However, the validity and clinical utility of this model remain unknown.

Methods

A total of 100 patients (79.6 ± 7 years, mean EuroScore 24.9 ± 16.3%, 41 males) constituted a validation cohort for the predictive model. Both angle (LVOT-AO) and depth to NCC were considered during patient selection and device implantation.

Results

Significant AR occurred in 16% (group A) vs. 84% (group B). Angle ∠LVOT-AO and depth to NCC were larger in group A compared to group B (16.4 ± 7.2 vs. 11.8 ± 4.1, p < 0.001, and 9.1 ± 4.8 mm vs. 6.6 ± 2.7 mm, p = 0.004). The model showed a sensitivity of 68.7% and a specificity of 88.1% in prediction of PAR. Comparing the derivation cohort (initial experience, n = 50) and validation cohort (later experience, n = 100) it is showed that the ∠LVOT-AO, valve depth and PAR were significantly lower (12.5 ± 4.9 and 6.9 ± 3.2 mm vs. 19.7 ± 7.9 and 10.4 ± 3.7 mm, 40% vs. 16% respectively, all p < 0.001) in the validation cohort.

Conclusion

The predictive model for significant PAR after TAVI using MCP is valid with a reassuring specificity and an acceptable sensitivity. A strategy incorporating these anatomical and procedural variables improves PAR after TAVI.