OBJECTIVES: To assess the association between ventricular septal wall thickness and residual para-valvular leak in patients undergoing trans-femoral aortic valve implantation (TAVI).
BACKGROUND: Increased septal wall thickness is a common finding in patients with severe aortic stenosis. The association between septal hypertrophy and the rate of para-valvular leak in patients undergoing TAVI is not known
METHODS: We conducted a retrospective analysis of 169 patients undergoing trans-femoral TAVI at our institute between the years 2009-2014. Septal wall thickness was measured using echocardiography done prior to the TAVI procedure, and the rate and severity of para-valvular leakage were assessed with echocardiography done after the procedure. Para-valvular leak severity was defined as none, mild, moderate and severe.
RESULTS: We found that 151 patients (89%) had no para-valvular leak, 11 (6.5%) patients had mild para-valvular leak, and 7 patients (4.5%) had moderate-severe para-valvular leak. Septal wall thickness range was 0.8-2.1 cm (mean 1.3 cm) and was not significantly different in patients with and without any para-valvular leak (mild to severe) (1.31cm vs. 1.29cm, p=0.95). Patients with moderate-severe para-valvular leak had thinner septal wall thickness compared to those with mild or no para-valvular leak (1.1 cm vs. 1.31 cm, p=0.016). 101 patients had a septal wall thickness of less or equal to 1.3 cm, and 68 patients had septal wall thickness of more than 1.3 cm. All 7 patients with moderate-severe para-valvular leak had a septal wall thickness of less or equal to 1.3 cm, and none had septal wall thickness of more than 1.3 cm (7/101 vs 0/68, p=0.027).
CONCLUSIONS: Septal wall thickness above 1.3 cm seems to be associated with less moderate-severe para-valvular leak following TAVI. This observation needs to be verified in larger cohort trials.
