Analysis Of Clinical Characteristics And Risk Factors Of Patients With Perivalvular Leakage After Transcatheter Aortic Valve Replacement

Objective:The objective of this study is to uncover the clinical characteristics and risk elements of those who experience moderate or greater perivalvular leakage(PVL)after transcatheter aortic valve replacement with a self-expanding valve,and to summarize the single-center experience in predicting the risk of PVL occurrence.Methods:A retrospective analysis of patients with severe aortic stenosis treated with TAVR at the Department of Cardiology,Second Affiliated Hospital of Nanchang University,was conducted between January 2018 and November 2022.The patients were divided into two group,PVL<3/4 and the PVL≥3/4,based on the ratio of aortic regurgitant bundle length to annular circumference measured by transesophageal echocardiography immediately after valve implantation.Baseline characteristics,echocardiographic,and imaging analysis results of patients in both groups were compared.A multifactorial logistic regression model was employed to screen independent risk factors for postoperative PVL≥3/4 in this study,and the predictive value of each risk factor for PVL≥3/4 was assessed by analyzing receiver operating characteristic(ROC)curves.Results:Including 107 patients,the average age was(71.7±7.0)years,with 63 males(58.9%).The PVL<3/4 group had 70 patients(65.4%),and the PVL≥3/4 group had37 patients(34.6%).A comparison between the two groups revealed that the proportion of males,left ventricular end-systolic diameter,valve ring diameter,left ventricular end-diastolic diameter,and aortic valve calcification volume were all greater in the PVL≥3/4 group than in the PVL<3/4 group(P<0.05).However,the relative wall thickness(RWT)was smaller in the PVL≥3/4 group than in the PVL<3/4group(P<0.05).In the PVL<3/4 group,the left ventricular ejection fraction(LVEF)was lower than that of the PVL≥3/4 group,yet the difference was not statistically significant(P=0.137).RWT was transformed into RWTd by taking its reciprocal.Use univariate logistic analysis to screen variables with P<0.10,then utilize multivariate logistic regression analysis to determine the independent potential elements for moderate or greater PVL after TAVR.The results revealed that RWTd(OR=2.697,95%CI 1.168～6.229,P=0.020)and aortic valve calcification volume(OR=1.001,95%CI 1.000～1.002,P=0.026)were independent risk factors for moderate or greater PVL after TAVR with a self-expanding valve.The ROC curve analysis showed that both RWTd(AUC=0.658,95%CI 0.554～0.763,P=0.007)and calcification volume(AUC=0.657,95%CI 0.554～0.759,P=0.008)can be used to predict the onset of moderate or greater PVL after TAVR.Conclusions:Patients with moderate or greater PVL have more severe preoperative left ventricular remodeling,and their lower left ventricular ejection fraction within the normal range.RWTd and aortic valve calcification volume are independent risk factors for the development of moderate or greater PVL after TAVR,and both have some predictive value for severe PVL after the procedure.