Optimal sizing for SAPIEN 3 transcatheter aortic valve replacement in patients with or without left ventricular outflow tract calcification EUROINTERVENTION Maeno, Y., Abramowitz, Y., Jilaihawi, H., Israr, S., Yoon, S., Sharma, R. P., Kazuno, Y., Kawamori, H., Miyasaka, M., Rami, T., Mangat, G., Takahashi, N., Okuyama, K., Kashif, M., Chakravarty, T., Nakamura, M., Cheng, W., Makkar, R. R. 2017; 12 (18): E2177–E2185


The impact of left ventricular outflow tract calcification (LVOT-CA) on SAPIEN 3 transcatheter aortic valve replacement (S3-TAVR) is not well understood. The aims of the present study were to determine optimal device sizing for S3-TAVR in patients with or without LVOT-CA and to evaluate the influence of residual paravalvular leak (PVL) on survival after S3-TAVR in these patients.This study analysed 280 patients (LVOT-CA=144, no LVOT-CA=136) undergoing S3-TAVR. Optimal annular area sizing was defined as % annular area sizing related to lower rates of =mild PVL. Annular area sizing was determined as follows: (prosthesis area/CT annulus area-1)×100. Overall, =mild PVL was present in 25.7%. Receiver operating characteristic curve analysis for prediction of =mild PVL in patients with LVOT-CA showed that 7.2% annular area sizing was identified as the optimal threshold (area under the curve [AUC] 0.71). Conversely, annular area sizing for no LVOT-CA appeared unrelated to PVL (AUC 0.58). Aortic annular injury was seen in four patients (average 15.5% annular area oversizing), three of whom had LVOT-CA. Although there was no difference in one-year survival between patients with =mild PVL and without PVL (log-rank p=0.91), subgroup analysis demonstrated that patients with =moderate LVOT-CA who had =mild PVL had lower survival compared to patients with =mild PVL and none or mild LVOT-CA (log-rank p=0.010).In the setting of LVOT-CA, an optimally sized S3 valve is required to reduce PVL and to increase survival following TAVR.

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View details for PubMedID 28117281