• Ramón Rodríguez-Olivares, Nahid El Faquir, Zouhair Rahhab, Lennart van Gils, Ben Ren, Rafi Sakhi, Marcel L Geleijnse, Ron van Domburg, de JaegerePeter P TPPTDepartment of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands., Jose L Zamorano Gómez, and Nicolas M Van Mieghem.
• Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands; Department of Cardiology, Ramón y Cajal University Hospital. Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Spain.
• Cardiovasc Revasc Med. 2019 Feb 1; 20 (2): 126-132.

AimsWe sought to evaluate the interaction of different aortic root phenotypes with self-expanding (SEV), balloon-expandable (BEV) and mechanically expanded (MEV) and the impact on significant aortic regurgitation.Methods And ResultsWe included 392 patients with a SEV (N = 205), BEV (N = 107) or MEV (N = 80). Aortic annulus eccentricity index and calcification were measured by multi-slice CT scan. Paravalvular aortic regurgitation was assessed by contrast aortography (primary analysis) and transthoracic echocardiography (secondary analysis). In mildly calcified roots paravalvular regurgitation incidence was similar for all transcatheter heart valves (SEV 8.4%; BEV 9.1%; MEV 2.0% p = 0.27). Conversely, in heavily calcified roots paravalvular regurgitation incidence was significantly higher with SEV (SEV 45.9%; BEV 0.0%; MEV 0.0% p < 0.001). When paravalvular regurgitation was assessed by TTE, the overall findings were similar although elliptic aortic roots were associated with more paravalvular regurgitation with SEV (20.5% vs. BEV 4.5% vs. MEV 3.2%; p = 0.009).ConclusionsIn heavily calcified aortic roots, significant paravalvular aortic regurgitation is more frequent with SEV than with BEV or MEV, but similar in mildly calcified ones. These findings may support patient-tailored transcatheter heart valve selection.ClassificationsAortic stenosis; multislice computed tomography; transcatheter aortic valve replacement; paravalvular aortic regurgitation.Condensed AbstractWe sought to evaluate the interaction of different aortic root phenotypes with self-expanding (SEV), balloon-expandable (BEV) and mechanically expanded (MEV) and the impact on significant aortic regurgitation. We included 392 patients with a SEV (N = 205), BEV (N = 107) or MEV (N = 80). Aortic annulus eccentricity index and calcification were measured by multi-slice CT scan. Paravalvular aortic regurgitation was assessed by contrast aortography and transthoracic echocardiography. We found that in heavily calcified aortic roots, significant paravalvular aortic regurgitation is more frequent with SEV than with BEV or MEV, but similar in mildly calcified ones.Copyright © 2018 Elsevier Inc. All rights reserved.

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