AUTHOR=Li Jie , Sun Yinghao , Zheng Shengneng , Li Guang , Dong Haojian , Fu Ming , Mo Yujing , Li Yi , Liu Huadong , Xu Zhaoyan , Zhang Liting , Cao Yong , Fan Ruixin , Lim D. Scott , Luo Jianfang 

TITLE=Anatomical Predictors of Valve Malposition During Self-Expandable Transcatheter Aortic Valve Replacement

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.600356

DOI=10.3389/fcvm.2021.600356

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> The consequence of valve malposition (VM) during transcatheter aortic valve replacement (TAVR) can be severe, but the determinants of VM with self-expandable TAVR have not been thoroughly evaluated. We aimed to investigate the anatomical predictors of VM during self-expandable TAVR.</p><p><bold>Methods:</bold> In this multicenter retrospective study, TAVR was performed using the Venus A-Valve. The baseline, computed tomography, and procedural characteristics along with clinical outcomes were collected. Multivariate logistic regression model and receiver operating characteristic (ROC) curve analyses were performed.</p><p><bold>Results:</bold> A total of 84 consecutive patients (23 with VM) were included. Stepwise regression showed that annulus perimeter/left ventricular outflow tract perimeter (AL ratio) and sinotubular junction (STJ) height were predictors of VM. The ROC curve indicated a moderate strength of AL ratio [area under the curve (AUC) 0.71, cutoff 0.96] and a weak strength of STJ height (AUC 0.69, cutoff 23.8 mm) to predict VM. The combination of both predictors revealed a higher predictive value of VM (AUC 0.77). In multivariate analysis, AL ratio &lt;0.96 [odds ratio (OR) 3.98, <italic>p</italic> = 0.015] and STJ height ≥23.8 mm (OR 4.63, <italic>p</italic> = 0.008) were strong independent predictors of VM. The presence of both predictors was associated with a very high risk of VM (OR 10.67, <italic>p</italic> = 0.002). The rate of moderate-to-severe paravalvular regurgitation was higher in patients with VM at 30 days (26.1 vs. 4.9%, <italic>p</italic> = 0.011).</p><p><bold>Conclusions:</bold> A conical left ventricular outflow tract and tall aortic sinuses were strong anatomical predictors of VM during self-expandable TAVR.</p>