Computed tomography predictors of structural valve degeneration in patients undergoing transcatheter aortic valve implantation with balloon-expandable prostheses

Objectives Computed tomography (CT) provides excellent anatomy assessment of the aortic annulus (AoA) and is utilized for pre-procedural planning of transcatheter aortic valve implantation (TAVI). We sought to investigate if geometrical characteristics of the AoA determined by CT may represent predictors of structural valve degeneration (SVD) in patients undergoing TAVI with balloon-expandable valves. Methods This is a retrospective study on 124 consecutive patients (mean age: 79 +/- 7 years; female: 61%) undergoing balloon-expandable TAVI prospectively enrolled in a registry. AoA maximum diameter (D-max), minimum diameter (D-min), and area were assessed using pre-procedural CT. SVD was identified during follow-up with transthoracic echocardiography documenting structural prosthetic valve abnormalities with or without hemodynamic changes. Results The mean follow-up was 5.9 +/- 1.7 years. SVD was found in 48 out of 124 patients (38%). AoA D-max, D-min, and area were significantly smaller in patients with SVD compared to patients without SVD (25.6 +/- 2.2 mm vs. 27.1 +/- 2.8 mm, p = 0.012; 20.5 +/- 2.1 mm vs. 21.8 +/- 2.1 mm, p = 0.001 and 419 +/- 77 mm(2) vs. 467 +/- 88 mm(2), p = 0.002, respectively). At univariable analysis, female sex, BSA, 23-mm prosthetic valve size, D-max < 27.1 mm, and a D-min < 19.9 mm were associated with SVD, whereas at multivariable analysis, only D-min < 19.9 mm (OR = 2.873, 95% CI: 1.191-6.929, p = 0.019) and female sex (OR = 2.659, 95% CI: 1.095-6.458, p = 0.031) were independent predictors of SVD. Conclusions Female sex and AoA D-min < 19.9 mm are associated with SVD in patients undergoing TAVI with balloon-expandable valves. When implanting large prostheses in order to avoid paraprosthetic regurgitation, caution should be observed due to the risk of excessive stretching of the AoA D-min,D- which may play a role in SVD.