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

Abstract

Objective: This study aimed to evaluate the influence of different degrees of multidetector computed tomography (MDCT)-based perimeter oversizing on the 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. The patients were divided into 2 groups (group I, below 13.9%; group II, above 13.9%) according to the degree of oversizing. Oversizing was calculated using the formula (device nominal perimeter/MDCT-derived annular perimeter-1)x100. Procedural and clinical data were evaluated using the valve academic research consortium definitions. Results: Mild or moderate PAR was present in 76.4% of the patients in group I and 34.4% of the patients in group II (p=0.009). The rate of CD tended to be lower in the group I (p=0.034). A cutoff value of 13.9% was identified as the best predictive value for mild or moderate PAR. Multivariate analysis identified a lower percentage of oversizing (odds ratio 6.38; 95% confidence interval 2.00-20.33; p=0.002) 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 was between 10% and 15%. Conclusion: Perimeter-based oversizing by MDCT inversely correlated with PAR after TAVI for the Portico device, and its preoperative evaluation could help in predicting PAR and CD.