PVL in ACURATE neo2 self-expanding aortic valve prosthesis for transcatheter aortic valve replacement - A multicenter retrospective registry analysis.

BACKGROUND

The self-expanding aortic valve prosthesis ACURATE neo2 features an extended external sealing skirt aiming to reduce postprocedural paravalvular leak (PVL). There is limited knowledge if PVL can be further reduced by dedicated implantation techniques. We aim to examine predictors of PVL after implantation of the ACURATE neo2 with focus on implantation technique.

METHODS

Patients undergoing ACURATE neo2 transcatheter aortic valve replacement (TAVR) at 3 centers were included in a retrospective registry. Patients were analyzed in 2 groups: PVL none/trace and PVL ≥ mild.

RESULTS

A total of 901 patients (mean age 81 ± 6 years, 57 % women) were included. On echocardiography before discharge, PVL was graded as none/trace, mild and moderate in 599 (67 %), 291 (32 %) and 6 (1 %), respectively. Implantation depth (OR 0.93 per mm, 95 % CI 0.88-0.99, p = 0.032) and commissural misalignment (>45°; OR 9.6, 95 % CI 1.9-48.6, p = 0.006) significantly predicted PVL ≥ mild. Other, non-modifiable predictors for PVL included LVOT calcification severity (OR 1.98, 95 % CI 1.24-3.16, p = 0.002), larger sinotubular junction diameter and sinus of valsalva diameter (OR 1.08 per mm, 95 % CI 1.02-1.13, p = 0.004 and OR 1.07 per mm, 95 % CI 1.04-1.12, p = 0.003, respectively).

CONCLUSIONS

A high implantation and commissural misalignment were associated with PVL ≥ mild after implantation of the ACURATE neo2. These findings may help to guide implantation technique and further improve clinical outcomes.