שכחתי לצרף את המאמר .אז אני מצרפת בהודעה זו

מתנצלת על הבלגן זה המאמר אליו התכוונתי Abstract 16150: The Impact of Annular Eccentricity and Cover Index on Paravalvular Leak After Transcatheter Aortic Valve Replacement Anvi Raina, Mohamad Hemu, Marie-France Poulin, Clifford J Kavinsky Originally published11 Nov 2019Circulation. 2019;140:A16150 Abstract Background: An eccentric annulus and a low cover index have been linked with increased paravalvular regurgitation (PVL) in transcatheter aortic valve replacement (TAVR). However, this phenomenon has not been studied with the third generation of transcatheter valves (Sapien 3 and Evolut Pro) which are outfitted with outer skirts to counteract PVL. Methods: An analysis of patients who underwent TAVR for degenerative aortic valve stenosis between January 2016 to March 2018 was done. Patients with bicuspid aortic valve and valve-in-valve TAVR were excluded. Pre-operative multidetector computed tomography (MDCT) and transthoracic echocardiogram (TTE) were analyzed. Annulus dimensions (mm) were measured using 3-mensio Structural HeartTM software to calculate eccentricity (1-minimum diameter/maximum diameter) and cover index (100 X (prosthesis diameter-mean annulus diameter)/prosthesis diameter). The primary endpoint was presence of mild PVL at discharge. Multivariate logistic regression adjusting for statistically and clinically significant univariates (age, aortic valve mean gradient, valve type, left ventricular outflow tract calcium area, volume, and severity) was performed. Results: A total of 269 patients were included. The mean age was 81 ± 8 years (51% male and 65% Caucasian). The average STS score was 5.9 ± 3.8%. Edwards Sapien 3 valves were used predominantly (79.1%), with the CoreValve Evolut being used for the remaining cases. 53 patients (19.7%) had mild of more PVL at discharge. In univariate analysis, the use of self-expandable valve was predictive of PVL (OR = 2.09, 95% CI: 0.07-0.23, p=0.037). Severity of left ventricular outflow tract calcium, calcium area, and volume were not predictive of mild PVL. In multivariate analysis, annulus eccentricity and cover index were not associated with increased PVL (OR = 1.30, 95% CI: 0.60-2.84, p=0.50 and OR = 2.11, 95% CI: 0.99-4.48, p=0.05 respectively). Conclusions: The presence of increased annular eccentricity and low cover index do not increase PVL in in TAVR with new generations of TAVR valves. These results need to be validated in larger cohorts with an emphasis on charting progression of PVL over time.