Beschreibung
Aortic valve stenosis (AS) is the most common valvular heart disease. Transcatheter aortic valve implantation (TAVI), originally approved for high-risk patients since 2002, is already implanted in low-risk patients in recent studies. Paravalvular leakage (PVL) remains one of the most common complications, particularly with the Acurate neoTM-prosthesis („Boston Scientific™”, Marlborough, MA, USA). PVL greater-equal to moderate (? 2°) are to be avoided as they are associated with increased mortality. Each subject received preprocedural echocardiography (“Philips Healthcare“, Hamburg, Germany) to confirm the diagnosis of AS and multidetector computed tomography (SOMATOM from „Siemens Healthcare®“, Forchheim, Germany) for procedure planning. Via a 14 Fr delivery-system (iSleeve („Boston Scientific™”, Marlborough, MA, USA)), the Acurate neoTM-prosthesis is advanced transfemorally to the aortic valve and unfolded using the "top-to-down" deployement. From 2012 to 2017, a total of 500 patients with a mean age of 81.9 years [IQA (interquartile range) 78.8-85.3] were treated using Acurate neoTM-prosthesis, of which 65.1 % (n = 324) were female. Two subjects did not receive echocardiography because of intraoperative conversion to open surgery and were excluded (n = 498). A PVL was classified into no-, mild-, moderate-, and severe PVL based on the proportion of circumferential AA according to Valve Academic Research Consortium (VARC-2) (47). A ? 2° PVL was diagnosed in 6.4 % (n = 32) of subjects at echocardiographic follow-up. A high native aortic valve calcium score (3,283 AU [IQA 2,348–4,069] (Agatston Unit) for PVLs ? 2° and 2,199 AU [IQA 1,561–2,911] for PVLs < 2° (p < 0.001)) and a too small cover-index calculated using the perimeter in systole (3.3 % [IQA 1.0-6.5] for PVL ? 2° and 5.0 % [IQA 2.9-7.3] for PVL < 2° (p = 0.007)) correlated significantly with PVL ? 2°. In particular, at the LCC, calcium volume correlated with PVLs ? 2° (CVAK-LCC: PVL ? 2° 236.0 mm3 [IQA 168.8–436.0] and PVL < 2° 134.0 mm3 [IQA 70.0–222.3] (p < 0.001)). Slight advancement of the delivery system during deployment significantly reduced PVLs (p = 0.001). In summary, to avoid PVLs, the Acurate neoTM requires a low calcium volume, especially at the LCC, and a slight oversizing. During implantation, a light contact with the native leaflets and a decent advancement towards the left ventricular is crucial.
