Association between annular eccentricity and initial post-deployment paravalvular leak before corrective maneuvers in bicuspid aortic valve patients undergoing self-expanding transcatheter aortic valve replacement: a single-center retrospective study.

Objective: The relationship between annular eccentricity and paravalvular leak (PVL) after transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) patients remains insufficiently defined, particularly for Chinese self-expanding valve platforms. This study evaluated the association between the CT-derived eccentricity index (EI) and initial post-deployment moderate-or-greater PVL after self-expanding TAVR in BAV patients. Methods: We retrospectively analyzed 194 consecutive BAV patients who underwent TAVR with the first-generation self-expanding VenusA valve. The primary endpoint was moderate-or-greater PVL assessed immediately after valve release and before corrective maneuvers such as post-dilatation. EI was measured by two independent observers with excellent interobserver agreement (ICC = 0.943). Multivariable logistic regression, ROC analysis, sensitivity analyses, and bootstrap internal validation were performed. NRI and IDI were analyzed as secondary measures of incremental information. Results: Initial post-deployment moderate-or-greater PVL occurred in 62 patients (32.0%). Although EI was modestly higher in patients with moderate-or-greater PVL than in those with no/mild PVL (median 0.23 [IQR 0.19-0.26] vs. 0.20 [0.17-0.25]; Conclusion: In BAV patients undergoing TAVR with the first-generation self-expanding VenusA valve, EI ≥0.19 was independently associated with initial post-deployment moderate-or-greater PVL, but its stand-alone and model-level discriminative performance were limited. EI should be considered a supplementary dimension in integrated preprocedural risk assessment rather than an isolated decision-making criterion.