Analysis of predictors of paravalvular leakage after transcatheter aortic valve implantation with fifth-generation self-expandable valve.

Paravalvular leakage (PVL) is one of the complications of transcatheter aortic valve implantation (TAVI), and its occurrence has been reported to affect long-term prognosis. We investigated whether the aortic valve calcification measured on preoperative CT is useful in predicting PVL after TAVI using the fifth-generation self-expanding valves. We analyzed 88 consecutive patients who underwent TAVI with the fifth-generation self-expanding valve from March 2023 to March 2024. Significant PVL was defined as PVL of mild or greater based on postoperative echocardiography results. We performed logistic regression analysis to evaluate whether patient background, and aortic valve calcification volume (AVCa-Vol), maximum CT value (AVCa-Max), mean CT value (AVCa-Ave), Agatston score (AV-Aga) and left ventricular outflow tract (LVOT) calcification volume measured by ECG-gated non-contrast CT were significant predictors. Mild or greater PVL was observed in 26 patients (29.5%). AVCa-Vol (1948.9 mm vs 1427.9 mm, P < 0.01), AV-Aga (2412.8 vs 1743.7, P < 0.01), and LVOT calcification volume (109.8 vs 28.6, P < 0.01) were significantly higher in the PVL group. Univariate logistic regression analysis identified AVCa-Vol and AV-Aga as significant predictors, and they remained independent predictors after adjustment for age and sex (AVCa-Vol: odds ratio (OR) 2.91 (95% Confidence Interval (CI) 1.36-6.20), P < 0.01, AV-Aga: OR 2.24 (95% CI 1.25-4.03), P < 0.01). Receiver operating characteristic analysis showed optimal cutoff values for AVCa-Vol at 1665.13 mm (Area under the curve (AUC) = 0.73) and AV-Aga at 1908.59 (AUC = 0.72). AVCa-Vol and AV-Aga were identified as significant predictors of PVL occurrence after TAVI using the fifth-generation self-expandable valve.