Turk Kardiyol Dern Ars. 2021; 49(3): 180-190 | DOI: 10.5543/tkda.2021.32582
Impact of different degrees of computed tomography-based oversizing on clinical outcomes after transcatheter aortic valve implantation using the Portico system
, Ali Rıza Demir
, Fatih Uzun
, Ömer Çelik
, Ali Kemal Kalkan
, Mehmet Ertürk
Department of Cardiology, University of Health Sciences İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
OBJECTIVE The study aimed to evaluate the influence of different degrees of multidetector computed tomography (MDCT)based perimeter oversizing on incidence and severity of paravalvular aortic regurgitation (PAR) and conduction disturbances (CD) for the Portico device.
METHODS We retrospectively analyzed 63 patients who underwent transcatheter aortic implantation (TAVI) in our center from March 2017 to June 2019. Patients were divided into two groups (group I, below %13.9; group II, above 13.9%) based on the degree of oversizing. Oversizing was calculated as (Device nominal perimeter / MDCT-derived annular perimeter - 1) * 100. Procedural and clinical data were evaluated by VARC-2 definitions.
RESULTS Mild or greater PAR was present in 76.4% of patients in group I and 34.4% of patients in group II (P = 0.009). The rate of CD tended to be lower in the patient's group I (P = 0.034). A cutoff value of 13.9% was identified as having the best predictive value for mild or greater PAR. On multivariate analysis, a lower percentage of oversizing (odds ratio 6.38; %95 confidence interval 2.00 - 20.33; P = 0.002) emerged as the most powerful independent predictor of PAR, whereas the implantation depth and severe oversizing were independent predictors of CD (P = 0.003 and P = 0.029, respectively). We demonstrated that the optimal acceptable perimeter-based oversizing range appears to be between 10 - 15%.
CONCLUSION Perimeter-based oversizing by MDCT inversely correlated with PAR after TAVI for Portico device, and its preoperative evaluation could help in predicting PAR and CD.
Conduction disturbance, paravalvular aortic regurgitation, Portico, transcatheter aortic valve implantation
How to cite this article
Serkan Aslan, Ali Rıza Demir, Fatih Uzun, Ömer Çelik, Ali Kemal Kalkan, Mehmet Ertürk. Impact of different degrees of computed tomography-based oversizing on clinical outcomes after transcatheter aortic valve implantation using the Portico system. Turk Kardiyol Dern Ars. 2021; 49(3): 180-190
Corresponding Author: Serkan Aslan, Türkiye