BACKGROUND: Computed tomography (CT) annular measurements are predictive of paravalvular regurgitation after transcatheter aortic valve replacement (TAVR) which is a predictor of mortality and morbidity. OBJECTIVES: To demonstrate the rationale and potential implications of new CT sizing recommendations for TAVR. METHODS: The CT sizing recommendations aim to ensure routine transcatheter heart valve (THV) oversizing of the aortic annular area [(THV external area/systolic annular area - 1) × 100; range, 1%-20%; target, 10%-15%]. Consecutive patients (n = 120) underwent CT before TAVR with balloon-expandable valves sized by transesophageal echocardiography (TEE). Retrospectively, the CT-recommended THV size was compared with the actual size implanted. RESULTS: Compared with TEE, application of the newly developed CT-based sizing recommendations would have led to implantation of a larger valve in 33.3% (40/120), no change in valve size in 55.8% (67/120), and a smaller valve in 10.8% (13/120). In patients when CT recommended a larger valve, the incidence of at least moderate paravalvular regurgitation was 25% (10/40) compared with 4.5% (3/67; P < 0.01) when both TEE and CT recommendations were in agreement. Using diastolic versus systolic CT measurements results in 20% of patients receiving smaller THVs. TEE sizing resulted in 33.3% (40/120) of valves being undersized (THV area < CT systolic annular area) with a mean annular oversizing of 9.4% ± 17.4% (range: -21.5% to 65.9%) without annular rupture. In contrast, the CT sizing recommendations results in mean annular oversizing of 13.9% ± 8.0% (range, 1.3%-29.8%). CONCLUSION: These CT sizing recommendations enable standardized moderate overexpansion of the aortic annulus. Clinical outcomes from these recommendations are being prospectively assessed in a multicenter trial.
BACKGROUND: Computed tomography (CT) annular measurements are predictive of paravalvular regurgitation after transcatheter aortic valve replacement (TAVR) which is a predictor of mortality and morbidity. OBJECTIVES: To demonstrate the rationale and potential implications of new CT sizing recommendations for TAVR. METHODS: The CT sizing recommendations aim to ensure routine transcatheter heart valve (THV) oversizing of the aortic annular area [(THV external area/systolic annular area - 1) × 100; range, 1%-20%; target, 10%-15%]. Consecutive patients (n = 120) underwent CT before TAVR with balloon-expandable valves sized by transesophageal echocardiography (TEE). Retrospectively, the CT-recommended THV size was compared with the actual size implanted. RESULTS: Compared with TEE, application of the newly developed CT-based sizing recommendations would have led to implantation of a larger valve in 33.3% (40/120), no change in valve size in 55.8% (67/120), and a smaller valve in 10.8% (13/120). In patients when CT recommended a larger valve, the incidence of at least moderate paravalvular regurgitation was 25% (10/40) compared with 4.5% (3/67; P < 0.01) when both TEE and CT recommendations were in agreement. Using diastolic versus systolic CT measurements results in 20% of patients receiving smaller THVs. TEE sizing resulted in 33.3% (40/120) of valves being undersized (THV area < CT systolic annular area) with a mean annular oversizing of 9.4% ± 17.4% (range: -21.5% to 65.9%) without annular rupture. In contrast, the CT sizing recommendations results in mean annular oversizing of 13.9% ± 8.0% (range, 1.3%-29.8%). CONCLUSION: These CT sizing recommendations enable standardized moderate overexpansion of the aortic annulus. Clinical outcomes from these recommendations are being prospectively assessed in a multicenter trial.
Authors: Borek Foldyna; Camelia Jungert; Christian Luecke; Konstantin von Aspern; Sonja Boehmer-Lasthaus; Eva Maria Rueth; Matthias Grothoff; Stefan Nitzsche; Matthias Gutberlet; Friedrich Wilhelm Mohr; Lukas Lehmkuhl Journal: Int J Cardiovasc Imaging Date: 2015-04-19 Impact factor: 2.357
Authors: Uri Landes; Alon Barsheshet; Ariel Finkelstein; Victor Guetta; Abid Assali; Amir Halkin; Hanna Vaknin-Assa; Amit Segev; Tamir Bental; Jeremy Ben-Shoshan; Israel M Barbash; Ran Kornowski Journal: Clin Cardiol Date: 2016-10-26 Impact factor: 2.882
Authors: Cihan Duran; Irfan Masood; Alper Duran; Luba Frank; Arsalan Saleem; Raja Muthupillai; Benjamin Y C Cheong Journal: Eurasian J Med Date: 2020-02
Authors: Damiano Caruso; Russell D Rosenberg; Carlo N De Cecco; Stefanie Mangold; Julian L Wichmann; Akos Varga-Szemes; Daniel H Steinberg; Andrea Laghi; U Joseph Schoepf Journal: Curr Cardiol Rep Date: 2016-02 Impact factor: 2.931
Authors: Quynh A Truong; Alan C Legasto; Roderick C Deaño; Daniel P Bachman; Deep Bhatt; Subhi J Al'Aref; Richard B Devereux; S Chiu Wong; Arash Salemi; Jackie Szymonifka Journal: Radiol Cardiothorac Imaging Date: 2019-08-29