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.
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.
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.
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.