Ct scan derived parameters predict left ventricle obstruction after tavi

Abstract Introduction Mid Ventricular (MVO) and Left Ventricular Outflow Tract Obstruction (LVOTO) after Trans–catheter Aortic Valve Implantation (TAVI) have been previously described and are associated with adverse outcome. Pre–procedural identification of patient at risk of MVO and LVOTO after TAVI may help pre–operative risk stratification and patient selection and facilitate intra–operative management, finally improving clinical outcomes. This study aims to identify CT–scan and Echocardiographic predictors of Left Ventricular Obstruction (LVO), defined as the composite of MVO and LVOTO. Methods We retrospectively reviewed pre–operative CT scans and Trans–Thoracic Echocardiography of 349 patients treated with TAVI at our Centre between January 2019 and December 2021. Correlations between post–operative development of MVO and LVOTO and pre–operative Echocardiographic and CT scan measurements were tested. Results LVO occurred in 16.3% of patients after TAVI. At univariate analysis clinical factors associated to LVO were female gender (OR=2.2, p=0.006) and body surface area (OR=0.19, p=0.006); pre–procedural echocardiographic parameters identified were end–diastolic–diameter (OR=0.89, p<0.001) and left ventricular ejections fraction (OR=1.09, p<0.001), whereas pre–procedural CT scan measurements associated to LVO were intraventricular septum to leaflet coaptation length (SLCL; OR=0.87, p<0.001) and left ventricular systolic area (OR=0.9, p<0.001). After multivariate analysis, only left ventricular ejection fraction (OR=1.1, p<0.001) and the CT scan derived parameters SLCL (OR=0.9, p<0.001) and left ventricular area (OR=0.9; p<0.001) were able to predict LVO after TAVI. Conclusions Left ventricle obstruction (LVOTO + MVO) after TAVI can be predicted by CT scan derived parameters. Pre–procedural identification of patients at risk may help intraprocedural and postprocedural management, thus improving clinical outcomes.