Study On The Predictive Value Of Aortic Root Anatomical Parameters For Perivalvular Leakage After Transcatheter Aortic Valve Replacement

ObjectiveTo investigate the risk factors of perivalvular leakage(PVL)after transcatheter aortic valve replacement(TAVR)in patients with severe aortic stenosis(AS)and to determine the predictive value of related risk factors for PVL after TAVR.Material and MethodPatients with severe AS who underwent TAVR surgery in the Department of Cardiology of the second affiliated hospital of nanchang university and the people’s hospital of jiangxi province from July 2017 to October 2021 were included.According to the results of transthoracic echocardiography before discharge,the patients were divided into two groups: non-PVL group and PVL group.PVL group included mild PVL group and moderate/severe PVL group.The preoperative baseline clinical features,preoperative ultrasound features,intraoperative data and preoperative aortic root CTA measurement indexes of the three groups were compared.Multivariate logistic regression model was used to screen the independent risk factors of PVL after TAVR.ROC curve analysis was used to observe the predictive value of risk factors for PVL after TAVR.The best cut-off value of related predictive factors was obtained by calculating Jordan index.ResultsA total of 128 patients were included,with an average age of 71.29±6.72 years,accounting for 57.8% of males.The incidence of PVL after TAVR was 48.5%(62/128),including 31.3%(40/128)of mild PVL and 17.2%(22/128)of moderate /severe PVL.Univariate analysis showed that the thickness of interventricular septum,moderate and above mitral regurgitation,stent implantation depth,bivalvular aortic valve(BAV),mean diameter of aortic annulus,mean diameter of left ventricular outflow tract(LVOT),the total volume of calcification in valvular region and the volume of calcification in LVOT were significantly different(P<0.05)in patients without PVL,mild PVL and moderate/severe PVL.The above variables were included in multivariate logistic regression analysis.The results showed that BAV(OR=3.345,95%CI 1.288～8.690,P=0.013),aortic valve calcification volume(OR=1.002,95%CI 1.001～1.003,P=0.001)and valve stent implantation depth(OR=1.344,95%CI 1.102～1.639,P=0.004)were independent risk factors for PVL after TAVR.ROC curve analysis showed that BAV(AUC=0.710,95%CI0.619～0.801,P<0.001),total aortic valve calcification volume(AUC=0.829,95%CI0.759～0.899,P<0.001)and valve stent implantation depth(AUC=0.750,95%CI0.658～0.842,P<0.001)could predict the occurrence of PVL after TAVR.When the total aortic valve calcification volume is larger than 863mm3,the sensitivity and specificity for predicting the occurrence of PVL after TAVR are 80.65% and 74.24%,while when the valve stent implantation depth is greater than 9.6mm,the sensitivity for predicting PVL after TAVR is 74.19% and the specificity is 86.36%.Conclusion1)BAV,total aortic valve calcification volume and valve stent implantation depth are independent risk factors for PVL in patients with severe AS after TAVR,which have a certain value in predicting the occurrence of postoperative PVL.2)When the type of aortic sinus was BAV,the total volume of aortic valve calcification was greater than 863mm3 or the depth of stent implantation was greater than 9.6mm,the sensitivity of predicting PVL after TAVR was 67.74%,80.65%,74.19%,and the specificity was 74.24%,74.24%,86.36%.3)The sensitivity and specificity of BAV,aortic valve calcification volume and stent placement depth combined to predict PVL after TAVR was 74.19% and 87.88%.