Victoria

Background: LT following transcatheter aortic valve replacement (TAVR) is a recognised entity. The association between prosthesis geometry with LT is unclear but maybe a potential modi fi able factor in its prevention. Aim: To determine the association between prosthesis geometry with leaf- let thrombosis (LT). Methods: Patients who received an intra-annular TAVR prosthesis and were prospectively planned to undergo post-procedural computed tomog-raphy (CT) imaging were included. LT was de fi ned as at least 50% restricted lea fl et motion on CT. Prosthesis expansion and eccentricity was measured at prosthesis in fl ow, annulus and out fl ow levels. Prosthesis mis- alignment was de fi ned as the average angle deviation between native and prosthesis lea fl et commissure, greater than 30 (cid:1) . Results: Prevalence of LT was 13.7% in 117 patients. None of the patients with LT were on anticoagulation therapy. Patients with LT had reduced prosthesis annular expansion (89.4 (cid:3) 5.2% vs 97.0 (cid:3) 4.4%, p<0.01), greater prosthesis misalignment (81.3% vs 48.5%, p=0.02) and deeper implants (6.3 (cid:3) 1.7mm vs 4.3 (cid:3) 1.5mm, p<0.01). Threshold for the presence of LT on ROC analysis was an implant depth of 5.7mm (AUC = 0.81). Independent predictors of LT were annular under- expansion (Odds ratio [OR] 1.4; 95% con fi dence interval [CI] 1.2 – 1.7, p=0.03), prosthesis misalignment (OR 6.8; 95%CI 1.1 – 45.5, p=0.04) and implant depth (OR 1.9; 95%CI 1.1 – 3.2, p=0.03). Anticoagulation therapy was a protective factor (OR 0.2; 95%CI 0.1 – 0.4, p<0.01). Conclusion: Geometrical predictors of LT post intra-annular TAVR were reduced prosthesis expansion at the annular level, lower implant depth and greater prosthesis misalignment. These factors may be important con- siderations during procedural planning for TAVR. Background: Vitamin D de fi ciency is a prevalent, modi fi able determinant of poor musculoskeletal health. Public health have aimed population