AI Article Synopsis
- Grading paravalvular leak (PVL) during TAVI deployment is difficult, and using invasive hemodynamic measurements can help improve grading and predict outcomes.
- The study examined 651 patients with severe aortic valve stenosis treated with self-expanding TAVI devices from 2008 to 2017, collecting various hemodynamic and echocardiographic data.
- The ARI ratio was identified as the strongest predictor of 1-year mortality, highlighting the importance of hemodynamic measures in assessing the risks associated with PVL during TAVI procedures.
Article Abstract
Grading paravalvular leak (PVL) at the time of transcatheter aortic valve implantation (TAVI) deployment is challenging. Per-procedural invasive hemodynamic measurements could serve to optimize PVL grading and predict outcome after TAVI. The aim of this study was to compare hemodynamic measures of paravalvular leak and their prognostic relevance in self-expanding TAVI devices. Between December 2008 and December 2017 consecutive patients treated for severe symptomatic aortic valve stenosis with self-expanding devices were prospectively studied. Peri-procedural hemodynamic measurements, echocardiographic data as well as clinical follow-up according to VARC-2 criteria were prospectively collected. Diastolic delta (DD), heart rate adjusted DD, aortic regurgitation index (ARI) and ARI ratio were calculated and assessed for their association with 1-year mortality. A total of 651 patients were studied. Moderate or severe paravalvular leakage was found in 4.8% of patients. ARI ratio < 0.6 (hazard ratio 1.96 [1.23-3.12], P = 0.005) was the best independent predictor of 1-year mortality. This study confirms the value of hemodynamic measures, specifically ARI ratio, for prognostication, potentially supporting procedural decision-making with regard to PVL.
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| http://dx.doi.org/10.1053/j.semtcvs.2020.11.025 | DOI Listing |
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