Optimal sizing for SAPIEN 3 transcatheter aortic valve replacement in patients with or without left ventricular outflow tract calcification.

Aims: The impact of left ventricular outflow tract calcification (LVOT-CA) on SAPIEN 3 transcatheter aortic valve replacement (S3-TAVR) is not well understood. The aims of the present study were to determine optimal device sizing for S3-TAVR in patients with or without LVOT-CA and to evaluate the influence of residual paravalvular leak (PVL) on survival after S3-TAVR in these patients. Methods and results: This study analysed 280 patients (LVOT-CA=144, no LVOT-CA=136) undergoing S3-TAVR. Optimal annular area sizing was defined as % annular area sizing related to lower rates of >= mild PVL. Annular area sizing was determined as follows: (prosthesis area/CT annulus area-1)x100. Overall, >= mild PVL was present in 25.7%. Receiver operating characteristic curve analysis for prediction of >= mild PVL in patients with LVOT-CA showed that 7.2% annular area sizing was identified as the optimal threshold (area under the curve [AUC] 0.71). Conversely, annular area sizing for no LVOT-CA appeared unrelated to PVL (AUC 0.58). Aortic annular injury was seen in four patients (average 15.5% annular area oversizing), three of whom had LVOT-CA. Although there was no difference in one-year survival between patients with >= mild PVL and without PVT. (log-rank 1 p=0.91), subgroup analysis demonstrated that patients with >= moderate LVOT-CA who had >= mild PVL had lower survival compared to patients with mild PVL and none or mild LVOT-CA (log-rank p=0.010). Conclusions: In the setting of LVOT-CA, an optimally sized S3 valve is required to reduce PVL and to increase survival following TAVR.