Aortic Root Morphological Characteristics Of Bicuspid Aortic Valve With CTA Assessment Before TAVR And Predictors Of Paravalvular Leakage After TAVR

Part 1:Aortic root morphological characteristics of bicuspid aortic valve under CTA assessment before TAVRObjective:This study aimed to describe the differences of aortic root morphological characteristics between patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) who underwent transcatheter aortic valve replacement (TAVR) using computed tomographic angiography (CTA).Methods:The consecutive patients underwent TAVR in the Second Affiliated Hospital of Zhejiang University from March 2013 to February 2016, were enrolled in this study. Patients with pure aortic regurgitation, after surgical aortic valve replacement, or implanted with non self-expandable valves were excluded from this study. The software 3mensio was used to assess the aortic root morphological characteristics and calcification volume of TAV and BAV patients.Results:A total of 119 consecutive patients were studied,75 (63.0%) of which were patients with TAV,34 (28.6%) were BAV type0, and 10 (8.4%) were BAV typel. The aortic annulus eccentricity of TAV patients was significantly larger than that of BAV typeO patients, yet there was no statistically significant difference of the annulus diameter between three groups. BAV typeO patients had larger sino-tubular junction and ascending aorta compared with TAV and BAV type1 patients (both P<0.05). No statistically significant difference was found between TAV and BAV typel patients. Calcification volumes of aortic valve area, left ventricular outflow tract (LVOT), and device landing zone were similar in three groups, while the calcification volume per leaflet was more severe in BAV typeO and BAV typel patients compared with TAV patients (both P<0.01). In addition, there were more BAV typeO patients presented with LVOT calcification than TAV patients (38.2% vs.18.7%, P=0.028).Conclusions:Significant differences were found between TAV and BAV patients, especially BAV typeO patients, who have less eccentrical annulus, larger sino-tubular junction and ascending aorta, more calcification volume per leaflet and higher LVOT calcification incidence.Part 2:Predictors of para valvular leakage in patients implanted with self-expandable valves after TAVRObjective:We sought to investigate the predictors of postprocedural paravalvular leakage (PVL) in patients implanted with self-expandable valves based on the demographic characteristics, preprocedural CTA measurements, transthoracic echocardiography (TTE) reports and periprocedural data, and analysed the difference of PVL between BAV and TAV patients.Methods:The consecutive patients who underwent TAVR in the Second Affiliated Hospital of Zhejiang University from March 2013 to February 2016, were enrolled in this study. Patients with pure aortic regurgitation, after surgical aortic valve replacement, implanted with non self-expandable valves, or without postprocedural TEE were excluded from this study. Univariate and multivariate ordinal logistic regression were performed with the outcome defined as the degree of PVL to identify potential predictors of PVL status. Postprocedural PVL was compared between BAV and TAV patients.Results:A total of 117 consecutive patients were studied,43 (36.8%) of which were patients with absent (grade 0) PVL,50 (42.7%) mild (grade 1) PVL,16 (13.7%) mild-moderate (grade 2) PVL, and 8 (6.8%) moderate (grade 3) PVL. No patients presented with PVL higher than grade 3. On multivariable analysis, the independent predictors of PVL status were:calcification volume of aortic valve area (OR 1.8,95%CI 1.2-2.8, P=0.008), mean implantation depth (OR 1.1,95%CI 1.0-1.2, P=0.016), and calcification volume of LVOT (OR 23.6,95%CI 1.4-391.4,P=0.027). BAV patients presented with more PVL ^ 1 than TAV patients (86.7% vs.58.3%, P=0.011) while mean implantation depth^ 4mm. However, the percentage of PVL=0 seemed to be higher in BAV patients than TAV patients (66.7%vs.38.5%, P=0.158) while valves were highly implanted (0< mean implantation depth<4mm). Incidence of PVL> grade 1 is similar in total patients with BAV vs. TAV (70.0% vs.58.9%, P=0.253).Conclusions:This study suggested that calcification volume of aortic valve area, mean implantation depth, and calcification volume of LVOT are independent predictors of PVL status. Non-inferior PVL status can be achieved in BAV patients vs. TAV patients with high implantation technique.