Impact of different degrees of computed tomography-based oversizing on clinical outcomes after transcatheter aortic valve implantation using the Portico system.

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.