Abstract 15214: Geometry No Longer Matters - Sphericity Index No Longer Predicts Aortic Regurgitation With SAPIEN 3 TAVR

Introduction: Despite the advent of the third generation transcatheter aortic valve replacement (TAVR) device, aortic regurgitation (AR) continues to be a known complication with significant impact on morbidity and mortality. We have evaluated our sphericity index (SI) for predicting development of significant AR post-TAVR in first and second generation TAVR devices. Hypothesis: We hypothesize that the degree of circularity of the aortic annulus on pre-TAVR multi detector computed tomography (MDCT) predicts development of post-TAVR significant AR in the third generation TAVR device. Methods: This was an observational, retrospective study, in which we reviewed data on 224 intermediate risk patients who underwent TAVR using the Edwards SAPIEN 3 valve at our institution from 2013-2016. Using MDCT, aortic annulus measurements were collected to calculate SI. SI was calculated by dividing the long diameter by the short diameter of the aortic annulus. Using the previous SI cutoff of 1.33 (corresponding to a 33% deviation from a circle), we used Fisher’s exact test on the third generation TAVR device in predicting development of significant AR post-TAVR. Significant AR was defined as moderate or severe AR. Pre-discharge transthoracic echocardiograms (TTEs) were used to determine degree of AR. All analyses were done using SAS 9.4® with a p-value Results: The 224 patients had a mean age of 82.4 ± 7.7 years, mean BMI of 28.9 ± 6.5 kg/m 2 , were 96.9% non-Hispanic Caucasian and 52.2% male. The mean SI was 1.25. In this population, there were 19.2% of patients who had an SI > 1.33. There were 3.1% of patients who developed significant AR of which all were paravalvular. There were 3.3% of patients with an SI of 1.33 or less who developed significant AR post-TAVR and 2.3% of patients with an SI above 1.33 who developed significant AR post-TAVR (p = 0.999). Conclusions: We have determined that the SI, previously predictive of significant AR in first and second generation TAVR devices, is not predictive of development of significant AR in the Edwards SAPIEN 3 valve. We hypothesize that technical advancements, including the outer sealing skirt, prevent paravalvular AR regardless of pre-TAVR aortic annulus geometry.