SPC365

TAVI paravalvular leaks – 1 year evaluation and Multimodal predictors

Session: SESSÃO DE COMUNICAÇÕES ORAIS 08 – OTIMIZAR RESULTADOS NA TAVI: PERFIL DO DOENTE, TÉCNICAS E VÁLVULAS
Speaker: Inês Caldeira Araújo

Congress: CPC 2025
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Comunicações Orais
FP Number: ---
Authors: Inês Caldeira Araújo; Miguel Azaredo Raposo; Ana Abrantes; Catarina Gregório; João Fonseca; Daniel Cazeiro; Diogo Ferreira; Cláudia Jorge; Miguel Nobre Menezes; João Silva Marques; Pedro Carrilho Ferreira; Fausto J. Pinto

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Paravalvular leak (PVL) is a common complication after transcatheter aortic valve implantation (TAVI), associated with adverse outcomes, including heart failure and reduced survival. Identifying predictors of PVL is essential for improving procedural outcomes and patient selection.</span></span></span></p>

<p>&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">To evaluate predictors of one-year TAVI moderate to severe PVL.&nbsp;</span></span></span></p>

<p>&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">We conducted a single center retrospective study, studying patients (pts) who underwent TAVI procedure 2014 to 2022 and had a 1-year follow-up echocardiographic evaluation. Baseline echocardiographic and CT-derived data were collected and analyzed. For statistical analysis Mann-Whitney, Chi-square tests and logistic regression were performed.&nbsp;</span></span></span></p>

<p>&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:&nbsp; </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">We included 743 pts, 54% of which were female, with a mean age of 82&plusmn;6,5 years.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">20% of pts had &ldquo;very severe AS&rdquo; defined as Vmax </span></span></span><span style="font-size:11pt"><span style="font-family:Symbol"><span style="color:#000000">&ge;</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">5m/s or mean gradient </span></span></span><span style="font-size:11pt"><span style="font-family:Symbol"><span style="color:#000000">&ge;</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">60mmHg. Aortic valve (AV) annular eccentricity [1-D(min)/D(max)] and AV calcium score were derived from cardiac CT &ndash; mean 3291&plusmn;1687 AU and median 0.15 (IQR 0.08) respectively. Valve type distribution was balanced, with 50% receiving balloon-expandable (BEV) and 50% self-expandable valves(SEV). Overexpansion index (OI) was calculated based on area for BEV and perimeter for SEV &ndash; median 14,4 (IQR 15.4). At echocardiographic evaluation before discharge, 61% had a minor and 3,5% moderate leaks. At 1-year reassessment, 35% had minor leaks, 4% moderate and 0.3% severe. PVL severity had worsened in 10% of pts and improved in 34% with 44% of pts completely resolving a previously existing PVL . Pts with an OI &gt;20% had a 3.88 higher odd of leak resolution at 1 year (p= 0.02). On bivariate analysis, significant associations were observed between 1-year moderate to severe PVL and eccentricity index; smallest AV diameter on CT; AV ring area; SEV vs BEV (p=0.002; OR 0.28 for SEV) and very severe AS (p=0.03; OR 2.3). AV calcium score and overexpansion index had no significant association.&nbsp;</span></span></span></p>

<p>&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> TAVI PVL was linked to annular eccentricity, smaller diameter, AV ring area, and valve type, with self-expandable valves reducing risk. Very severe aortic stenosis increased PVL risk, while greater overexpansion improved leak resolution. Pre-procedural imaging and valve selection remain critical to minimizing PVL.</span></span></span></p>

<p>&nbsp;</p>