open access

Vol 24, No 5 (2017)
Original articles — Interventional cardiology
Published online: 2017-02-01
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Impact of CoreValve size selection based on multi-slice computed tomography on paravalvular leak after transcatheter aortic valve implantation

Piotr Chodór, Krzysztof Wilczek, Roman Przybylski, Jan Głowacki, Tomasz Kukulski, Witold Streb, Tomasz Niklewski, Grzegorz Honisz, Przemysław Trzeciak, Tomasz Podolecki, Łukasz Włoch, Marian Zembala, Zbigniew Kalarus
DOI: 10.5603/CJ.a2017.0014
·
Pubmed: 28150295
·
Cardiol J 2017;24(5):467-476.

open access

Vol 24, No 5 (2017)
Original articles — Interventional cardiology
Published online: 2017-02-01

Abstract

Background: Paravalvular leak (PVL) has significant impact on long-term outcomes in patients after transcatheter aortic valve implantation (TAVI). This study sought to determine whether multi-slice computed tomography (MSCT)-guided valve selection reduces PVL after CoreValve implantation.

Methods: The analysis encompassed 69 patients implanted with CoreValve and were divided into two groups. In Group I (30 patients), valve selection was based on standard procedures, in Group II (39 patients), on MSCT measurements. Paravalvular leak was assessed with angiography and echocardiography.

Results: Multi-slice computed tomography results influenced a change of decision as to the size of the implanted valve in 12 (30.9%) patients in Group II and would have caused the decision to change in 9 (37.5%) patients in Group I. The degree of oversizing in Group I and II was 12.8% ± ± 7.6% vs. 18.6% ± 5.1% (p = 0.0006), respectively. The oversizing among the patients with leak degree of 0–1 and ≥ 2 was 18.1% ± 6.0% and 12.8% ± 7.4% (p = 0.0036). Angiographic assessment indicated post-procedural PVL ≥ 2 in 50% of patients in Group I and 20.5% in Group II (p = 0.01), while echocardiographic assessment indicated the same in 73.3% of patients in Group I and 45.6% in Group II (p = 0.0136). The composite endpoint occurred in 26.6% (8/30) patients in Group I vs. 5.1% (2/39) patients in Group II (p = 0.0118).

Conclusions: Selecting the CoreValve device based on MSCT resulted in smaller rates of PVL and less frequent composite endpoint. In 1/3 of patients MSCT led to a change of the valve size. The degree of oversizing had a significant impact on PVL.

Abstract

Background: Paravalvular leak (PVL) has significant impact on long-term outcomes in patients after transcatheter aortic valve implantation (TAVI). This study sought to determine whether multi-slice computed tomography (MSCT)-guided valve selection reduces PVL after CoreValve implantation.

Methods: The analysis encompassed 69 patients implanted with CoreValve and were divided into two groups. In Group I (30 patients), valve selection was based on standard procedures, in Group II (39 patients), on MSCT measurements. Paravalvular leak was assessed with angiography and echocardiography.

Results: Multi-slice computed tomography results influenced a change of decision as to the size of the implanted valve in 12 (30.9%) patients in Group II and would have caused the decision to change in 9 (37.5%) patients in Group I. The degree of oversizing in Group I and II was 12.8% ± ± 7.6% vs. 18.6% ± 5.1% (p = 0.0006), respectively. The oversizing among the patients with leak degree of 0–1 and ≥ 2 was 18.1% ± 6.0% and 12.8% ± 7.4% (p = 0.0036). Angiographic assessment indicated post-procedural PVL ≥ 2 in 50% of patients in Group I and 20.5% in Group II (p = 0.01), while echocardiographic assessment indicated the same in 73.3% of patients in Group I and 45.6% in Group II (p = 0.0136). The composite endpoint occurred in 26.6% (8/30) patients in Group I vs. 5.1% (2/39) patients in Group II (p = 0.0118).

Conclusions: Selecting the CoreValve device based on MSCT resulted in smaller rates of PVL and less frequent composite endpoint. In 1/3 of patients MSCT led to a change of the valve size. The degree of oversizing had a significant impact on PVL.

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Keywords

paravalvular leak, aortic valve stenosis, transcatheter aortic valve implantation, CoreValve, multi-slice computed tomography

About this article
Title

Impact of CoreValve size selection based on multi-slice computed tomography on paravalvular leak after transcatheter aortic valve implantation

Journal

Cardiology Journal

Issue

Vol 24, No 5 (2017)

Pages

467-476

Published online

2017-02-01

DOI

10.5603/CJ.a2017.0014

Pubmed

28150295

Bibliographic record

Cardiol J 2017;24(5):467-476.

Keywords

paravalvular leak
aortic valve stenosis
transcatheter aortic valve implantation
CoreValve
multi-slice computed tomography

Authors

Piotr Chodór
Krzysztof Wilczek
Roman Przybylski
Jan Głowacki
Tomasz Kukulski
Witold Streb
Tomasz Niklewski
Grzegorz Honisz
Przemysław Trzeciak
Tomasz Podolecki
Łukasz Włoch
Marian Zembala
Zbigniew Kalarus

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