# A Retrospective Analysis Assessing Paravalvular Leak and Pacemaker Implantation Using TEE and Non‐Contrast CT for CKD Patients Compared With CT Angiography for Annular Sizing Pre‐TAVR

## TL;DR

This study shows that using TEE and non-contrast CT for aortic annular sizing in CKD patients undergoing TAVR leads to similar outcomes as CT angiography.

## Contribution

The study introduces a contrast-sparing protocol for TAVR pre-procedure evaluation in CKD patients.

## Key findings

- No significant difference in paravalvular leak rates between TEE/CT non-contrast and CTA groups.
- No difference in permanent pacemaker implantation rates between the two groups.
- TEE and non-contrast CT may be a viable alternative to CTA for CKD patients.

## Abstract

Transcatheter aortic valve replacement (TAVR) has become the treatment of choice for many patients with severe aortic stenosis. Proper pre‐procedure sizing of the aortic annulus is crucial in preventing post‐TAVR complications. This is typically performed with CT angiography, but the use of contrast is controversial in patients with chronic kidney disease (CKD).

This study of 557 patients from 2016 to 2021 sought to evaluate a contrast‐sparing protocol for balloon expandable TAVR evaluation in patients with CKD, in which patients with glomerular filtration rate of less than 40 would undergo transesophageal echocardiogram (TEE) and CT without contrast (83 patients) for aortic annular sizing instead of CT angiography (445 patients).

We found that there was no significant difference in rates of greater than trace or greater than mild paravalvular leak between the two groups at hospital discharge, 30 days, or 1‐year post‐TAVR. We also found no difference in rates of permanent pacemaker implantation at these same time points.

This suggests that TEE and non‐contrast CT could be a viable alternative to CTA in patients with CKD, although more research into other variables such as mortality and other post‐procedural complications is necessary.

We performed a retrospective cohort study on over 500 TAVR recipients between 2016 and 2021 to compare rates of PVL and PPM implantation at up to 1 year postprocedure between groups who underwent TEE and non‐contrast CT and those who underwent CTA. We found no significant difference in incidence of PVL or PPM implantation between TEE/CT non‐contrast and CTA at discharge, 30 days, or 1 year, indicating that TEE/non‐contrast CT may be a viable alternative to CTA in CKD patients.

We performed a retrospective cohort study on over 500 TAVR recipients between 2016 and 2021 to compare rates of PVL and PPM implantation at up to 1 year postprocedure between groups who underwent TEE and non‐contrast CT and those who underwent CTA. We found no significant difference in incidence of PVL or PPM implantation between TEE/CT non‐contrast and CTA at discharge, 30 days, or 1 year, indicating that TEE/non‐contrast CT may be a viable alternative to CTA in CKD patients.