ABC | Volume 111, Nº2, August 2018

Original Article The Role of Quantitative Aortographic Assessment of Aortic Regurgitation by Videodensitometry in the Guidance of Transcatheter Aortic Valve Implantation Yosuke Miyazaki, 1 Rodrigo Modolo, 2,3 Mohammad Abdelghani, 2 Hiroki Tateishi, 4 Rafael Cavalcante, 1 Carlos Collet, 2 Taku Asano, 2 Yuki Katagiri, 2 Erhan Tenekecioglu, 1 Rogério Sarmento-Leite, 5 José A. Mangione, 6 Alexandre Abizaid, 7 Osama I.I. Soliman, 1,8 Yoshinobu Onuma, 1,8 Patrick W. Serruys, 9 Pedro A. Lemos, 10 Fabio S. de Brito Jr. 11 Department of Cardiology - Thoraxcenter, Erasmus Medical Center Rotterdam, 1 Rotterdam – Netherlands Department of Cardiology - the Academic Medical Center - University of Amsterdam, 2 Amsterdam – Netherlands Departamento de Medicina Interna - Divisão de Cardiologia - Universidade de Campinas (UNICAMP), 3 Campinas, SP – Brazil Division of Cardiology - Department of Clinical science and Medicine - Yamaguchi University Graduate School of Medicine, 4 Ube, Yamaguchi – Japan Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia e Universidade Federal de Ciências da Saúde de Porto Alegre, 5 Porto Alegre, RS – Brazil Hospital Beneficência Portuguesa de São Paulo, 6 São Paulo, SP – Brazil Instituto Dante Pazzanese de Cardiologia, 7 São Paulo, SP – Brazil Cardialysis, Rotterdam – Netherlands NHLI, Imperial College London, 9 London – United Kingdom Hospital Israelita Albert Einstein, 10 São Paulo, SP – Brazil Instituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo, 11 São Paulo, SP – Brazil Mailing Address: Patrick W. Serruys • P.O. Box 2125, 3000 CC. Rotterdam – Netherlands E-mail: patrick.w.j.c.serruys@gmail.com , patrick.w.j.c.serruys@pwserruys.com Manuscript received November 29, 2017, revised manuscript February 18, 2018, accepted March 07, 2018 DOI: 10.5935/abc.20180139 Abstract Background: Balloon post-dilatation (BPD) is often needed for optimizing transcatheter heart valve (THV) implantation, since paravalvular leak (PVL) after transcatheter aortic valve implantation is associated with poor outcome and mortality. Quantitative assessment of PVL severity before and after BPD is mandatory to properly assess PVL, thus improving implantation results and outcomes. Objective: To investigate a quantitative angiographic assessment of aortic regurgitation (AR) by videodensitometry before and after BPD. Methods: Videodensitometric-AR assessments (VD-AR) before and after BPD were analysed in 61 cases. Results: VD-AR decreased significantly from24.0[18.0-30.5]% to 12.0[5.5-19.0]% (p<0.001, a two-tailed p<0.05 defined thestatisticalsignificance).TherelativedeltaofVD-ARafterBPDrangedfrom-100%(improvement)to+40%(deterioration) and its median value was -46.2%. The frequency of improvement, no change, and deterioration were 70% (n = 43), 25% (n = 15) and 5% (n = 3), respectively. Significant AR (VD-AR > 17%) was observed in 47 patients (77%) before and in 19 patients (31%) after BPD. Conclusions: VD-AR after THV implantation provides a quantitative assessment of post-TAVI regurgitation and can help in the decision-making process on performing BPD and in determining its efficacy. (Arq Bras Cardiol. 2018; 111(2):193-202) Keywords: Aortic Valve Insufficiency/diagnostic imaging; Angiography/evaluation; Heart Valve Prosthesis Implantation; Transcatheter Aortic Valve Replacement. Introduction Balloon post-dilatation (BPD) is often needed for optimizing transcatheter heart valve (THV) implantation, since paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) is associated with long- term fatal prognosis. 1-5 The incidence of moderate or severe PVL following TAVI varies from 0% to 24% and that of mild PVL from 7% to 70%. 6 BPD is performed in 21% to 28% of cases with the first generation THVs. 7, 8 Although newer generations of THVs have been designed to reduce the PVL, BPD is still performed in up to 17% of cases receiving the new generation of THVs. 7,9,10 Therefore, BPD remains one important technique to optimize implantation of the THV. The Valve Academic Research Consortium-2 (VARC-2) consensus document recommends to perform quantitative and semi-quantitative hemodynamic assessments of PVL severity and other definitions for valve failure than mild PVL only. 11 TAVI under conscious sedation is increasingly adopted 193