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FD is a mathematical concept that describes geometric complexity of a structure and has been shown to predict adverse outcomes in several contexts. Computed tomography (CT) scans from the SOLVE-TAVI trial, which, in a 2\u2009\u00d7\u20092 factorial design, randomized 447 patients to TAVI with the balloon-expandable Edwards Sapien 3 or the self-expanding Medtronic Evolut R, and conscious sedation or general anesthesia, were analyzed semi-automatically with a custom-built software to determine border of AA and LVOT. FD was measured by box counting using grid calibers between 0.8 and 6.75\u00a0mm and was compared between patients with none\/trivial and mild\/moderate paravalvular regurgitation (PVR). Overall, 122 patients had CT scans sufficient for semi-automatic PVR in 30-day echocardiography. PVR was none in 65(53.3%) patients, trace in 9(7.4%), mild in 46(37.7%), moderate in 2(1.6%) and severe in 0 patients. FD determined in diastolic images was significantly higher in patients with mild\/moderate PVR (1.0558\u2009\u00b1\u20090.0289 vs. 1.0401\u2009\u00b1\u20090.0284, p\u2009=\u20090.017). Annulus eccentricity was the only conventional measure of AA and LVOT geometry significantly correlated to FD (R\u2009=\u20090.337, p\u2009&lt;\u20090.01). Area under the curve (AUC) of diastolic annular FD for prediction of mild\/moderate PVR in ROC analysis was 0.661 (0.542\u20130.779, p\u2009=\u20090.014). FD shows promise in prediction of PVR after TAVI. Further evaluation using larger patient numbers and refined algorithms to better understand its predictive performance is warranted.<\/jats:p><jats:p><jats:bold>Trial Registration:<\/jats:bold><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov\">www.clinicaltrials.gov<\/jats:ext-link>, identifier: NCT02737150, date of registration: 13.04.2016.<\/jats:p>","DOI":"10.1007\/s10554-022-02657-1","type":"journal-article","created":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T20:12:21Z","timestamp":1656101541000},"page":"2469-2478","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Fractal dimension of the aortic annulus: a novel predictor of paravalvular leak after transcatheter aortic valve implantation"],"prefix":"10.1007","volume":"38","clinical-trial-number":[{"clinical-trial-number":"nct02737150","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Georg","family":"Stachel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Abdel-Wahab","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzanne","family":"de Waha-Thiele","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steffen","family":"Desch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans-Josef","family":"Feistritzer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitsunobu","family":"Kitamura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serdar","family":"Farhan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ingo","family":"Eitel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Kurz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Holger","family":"Thiele","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,6,24]]},"reference":[{"key":"2657_CR1","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1002\/ccd.27336","volume":"91","author":"T Ando","year":"2018","unstructured":"Ando T, Briasoulis A, Telila T, Afonso L, Grines CL, Takagi H (2018) Does mild paravalvular regurgitation post transcatheter aortic valve implantation affect survival? 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