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Article

Value of Post-/Pre-Procedural Aortic Regurgitation Ratio vs. Pre-Procedural Aortic Valve Calcium Score to Predict Moderate to Severe Paravalvular Leak Requiring Post-Dilation after Transcatheter Aortic Valve Implantation

by
Roman Uebelacker
1,
Simon S. Martin
2,
Mariuca Vasa-Nicotera
1,3,4 and
Silvia Mas-Peiro
1,3,4,*
1
Department of Cardiology, University Hospital Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
2
Department of Radiology, University Hospital Frankfurt am Main, 60590 Frankfurt am Main, Germany
3
German Centre for Cardiovascular Research (DZHK), 10785 Berlin, Germany
4
Cardiopulmonary Institute (CPI), 60590 Frankfurt am Main, Germany
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2023, 12(24), 7735; https://doi.org/10.3390/jcm12247735
Submission received: 20 October 2023 / Revised: 1 December 2023 / Accepted: 14 December 2023 / Published: 17 December 2023
(This article belongs to the Special Issue Transcatheter Aortic Valve Replacement in 2021 and Beyond)
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Abstract

Background and aim: Tools that assist interventionists in selecting patients for post-dilation (PD) are needed. We aimed to assess whether pre-interventional aortic valve calcium (AVC) or the peri-interventional aortic regurgitation (ARI) ratio is a better predictor for a more than mild paravalvular leak (PVL) requiring PD after TAVI. Methods: Patients undergoing TAVI with available data on AVC derived from MSCTs and the ARI ratio derived from peri-interventional hemodynamic curves were studied. The main outcome was moderate-to-severe PVL requiring PD. Results: In 237 patients, more than mild PVL after valve deployment was present in 25.7%. PD was performed in 65 patients. The median (IQR) total AVC was 390.5 (211.5–665.4) mm3. All calcification values were significantly higher in patients who underwent PD. The median (IQR) individual threshold was 600 (550–685) Hus. The overall ARI ratio was 0.78 (0.61–0.96), with values being significantly lower in patients who underwent PD: 0.61 (0.49–0.80) vs. 0.82 (0.69–0.99) (p < 0.001). Both the ARI ratio (OR [95%CI] 0.053 [0.014–0.203]; p < 0.001) and AVC (1.01 [1.000–1.002]; p = 0.015) predicted PD need. ROC curves showed higher discrimination for the ARI ratio (AUC 0.73) than for any calcification parameter (all AUCs ≤ 0.62). Conclusions: The ARI ratio provides interventionists with a powerful predictive tool for PVL requiring PD after TAVI that is beyond the predictive value of pre-procedural valve calcification derived from MSCT.
Keywords: aortic valve stenosis; transcatheter aortic valve implantation; aortic regurgitation index; calcification; post-dilation aortic valve stenosis; transcatheter aortic valve implantation; aortic regurgitation index; calcification; post-dilation

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MDPI and ACS Style

Uebelacker, R.; Martin, S.S.; Vasa-Nicotera, M.; Mas-Peiro, S. Value of Post-/Pre-Procedural Aortic Regurgitation Ratio vs. Pre-Procedural Aortic Valve Calcium Score to Predict Moderate to Severe Paravalvular Leak Requiring Post-Dilation after Transcatheter Aortic Valve Implantation. J. Clin. Med. 2023, 12, 7735. https://doi.org/10.3390/jcm12247735

AMA Style

Uebelacker R, Martin SS, Vasa-Nicotera M, Mas-Peiro S. Value of Post-/Pre-Procedural Aortic Regurgitation Ratio vs. Pre-Procedural Aortic Valve Calcium Score to Predict Moderate to Severe Paravalvular Leak Requiring Post-Dilation after Transcatheter Aortic Valve Implantation. Journal of Clinical Medicine. 2023; 12(24):7735. https://doi.org/10.3390/jcm12247735

Chicago/Turabian Style

Uebelacker, Roman, Simon S. Martin, Mariuca Vasa-Nicotera, and Silvia Mas-Peiro. 2023. "Value of Post-/Pre-Procedural Aortic Regurgitation Ratio vs. Pre-Procedural Aortic Valve Calcium Score to Predict Moderate to Severe Paravalvular Leak Requiring Post-Dilation after Transcatheter Aortic Valve Implantation" Journal of Clinical Medicine 12, no. 24: 7735. https://doi.org/10.3390/jcm12247735

APA Style

Uebelacker, R., Martin, S. S., Vasa-Nicotera, M., & Mas-Peiro, S. (2023). Value of Post-/Pre-Procedural Aortic Regurgitation Ratio vs. Pre-Procedural Aortic Valve Calcium Score to Predict Moderate to Severe Paravalvular Leak Requiring Post-Dilation after Transcatheter Aortic Valve Implantation. Journal of Clinical Medicine, 12(24), 7735. https://doi.org/10.3390/jcm12247735

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