Can we predict postprocedural paravalvular leak after Edwards SAPIEN transcatheter aortic valve implantation?

Background Postprocedural paravalvular leak (PVL)≥2 has been shown to be associated with worse outcomes after transcatheter aortic valve implantation (TAVI). This study sought to identify predictive factors of postprocedural PVL≥2 after TAVI with the Edwards valve. Methods and Results A total of 176 patients with Edwards TAVI (aged 83.4±7.4 years, Logistic EuroSCORE [the Logistic European System for Cardiac Operative Risk Evaluation] 18.8±12.0, transfemoral 54.5%) who had preprocedural multidetector computed tomography (MDCT) were studied. A PVL≥2 was observed in 12.5% of cases. By multivariate analysis, only the valve calcification index (VCI) defined as aortic root calcification volume/body surface area (odds ratio [OR]=1.002, 95% confidence interval [CI]=1.001-1.004, P=0.006) and the valve diameter/the calculated average annulus diameter (CAAD) by MDCT (OR=0.683, 95% CI=0.474-0.984, P=0.041) were identified as independent predictors of postprocedural PVL≥2. A score predicting postprocedural PVL≥2 (PVL score) was determined by allotting one point when the valve diameter/CAAD ratio was <1.055 and one point when VCI was >418.4 mm³/m², and summing all points accrued. Area under receiver-operator characteristic curves of PVL score was 0.71 (95% CI=0.59-0.83, P<0.01). The incidence of PVL≥2 was 5.3% in patients with a PVL score of 0, 11.8% for a PVL score of 1 and 37.5% for a PVL score of 2. Conclusions The only predictors of PVL≥2 after Edwards valve implantation are the valve diameter/CAAD and VCI. The PVL score could prove to be an excellent tool for predicting the risk of PVL.