Determinants of Significant Paravalvular Regurgitation After Transcatheter Aortic Valve ImplantationImpact of Device and Annulus Discongruence
Delphine Détaint, MD*,
Laurent Lepage, MD,
Dominique Himbert, MD,
Eric Brochet, MD,
David Messika-Zeitoun, MD,
Bernard Iung, MD,
Alec Vahanian, MD
Cardiology Department, Hopital Bichat, Paris, France
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Figure 1 AR Evaluation in the 16 Patients With AR  2/4
Assessment of aortic regurgitation (AR) grade in the 16 patients with paravalvular AR 2/4, immediately after valve implantation (on the left), after balloon re-dilation (if performed), at the end of the procedure after potential second prosthesis implantation and at 7 days (on the right). Grade of AR are indicated on the left. Solid lines indicate evolution of AR in patients undergoing balloon re-dilation. Double solid lines indicate evolution of AR after implantation of a second prosthesis. Dotted lines represent evolution of AR in patients who did not undergo balloon re-dilation or implantation of a second prosthesis. D4 = day 4 (this patient died 4 days after TAVI); TAVI = transcatheter aortic valve implantation.
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Figure 2 Assessment of AR in the Study Population
Evaluation of paravalvular AR in 4 grades, immediately after valve implantation (left), at the end of the procedure after potential re-dilation or second prosthesis implantation (middle), and at 7 days (right). Number of patients in each grade is indicated on each bar. Abbreviations as in Figure 1.
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Figure 3 TTE Aortic Annulus Dimensions in Patients With AR <2/4 and 2/4
Scatter plots aortic annulus dimension measured with transthoracic echocardiography (TTE) stratified according to paravalvular aortic regurgitation (AR) classified as mild or less (AR <2/4) and at least of moderate degree (AR 2/4). The mean and SD are represented by the bars in each groups. The dotted line indicates the value of aortic annulus (22 mm) under which significant AR is never observed.
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Figure 4 TEE Aortic Annulus Dimensions in Patients With AR <2/4 and 2/4
Scatter plots aortic annulus dimension measured with transesophageal echocardiography (TEE) stratified according to paravalvular aortic regurgitation (AR) classified as mild or less (AR <2/4) and at least of moderate degree (AR 2/4). The mean and SD are represented by the bars in each groups. The dotted line indicates the value of aortic annulus (22 mm) under which significant AR is never observed.
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Figure 5 Distribution of Prosthesis-Annulus Cover Index
Distribution of prosthesis-annulus cover index defined as 100 x ([prosthesis diameter – TEE annulus diameter]/prosthesis diameter). Bar height represents the number of patients. Solid bars indicate patients with AR 2/4, and open bars indicate patients with AR <2/4. As shown with the dotted line, AR 2/4 was never observed in patients with cover index >8%. Abbreviations as in Figure 4.
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