Alexandros Papachristidis1, Michael Papitsas2, Damian Roper2, Yanzhong Wang3, Rafal Dworakowski2, Jonathan Byrne2, Olaf Wendler4, Philip MacCarthy2, Mark J Monaghan2. 1. Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom. Electronic address: alexandros.papachristidis@nhs.net. 2. Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom. 3. Department of Primary Care and Public Health Sciences, Addison House, Guy's Campus, King's College London, London, United Kingdom. 4. Department of Cardiothoracic Surgery, King's College Hospital NHS Foundation Trust, London, United Kingdom.
Abstract
BACKGROUND: The use of transcatheter aortic valve replacement (TAVR) is increasing worldwide. We present our 6-year experience using three-dimensional (3D) transesophageal echocardiography (TEE) and investigate whether different sizing methods of the aortic annulus lead to different prosthesis size that may impact outcome. METHODS: We investigated 262 patients who underwent TAVR and had 3D TEE data sets of the aortic annulus. We have used the area-derived diameter (Darea = 2(area/π)) and the circumference-derived diameter (Dcirc = Circumference/π) to size the prosthesis in separate populations in different time periods. RESULTS: The Dcirc method is correlated with lower incidence of paravalvular aortic regurgitation (PVAR; odds ratio = 0.44, 95% confidence interval, 0.23-0.85; P = .015). Other factors associated with PVAR were the cover index, area-mismatch index, and circumference-mismatch index. Retrospectively, for the purposes of the study, we used the Edwards-Sapien 3 Valve 3D sizing guide in all patients, to predict the hypothetical valve size with each method. In the whole population, the calculated Dcirc was higher in all cases (Dcirc = 23.4 ± 2.3 mm vs Darea = 22.9 ± 2.3 mm; P < .001). The two methods had good agreement in predicting the valve size (kappa = 0.600). In total, 192 (73.3%) patients were assigned for the same prosthesis size, whereas 70 (26.7%) would be eligible for a different size, of which 44 (16.7%) would definitely have had a different valve implanted. CONCLUSION: Using the aortic annulus area or circumference to calculate the annular diameter provides different values. Comparing the two methods, a different prosthesis size could have been implanted in 26.7% of patients. In our series the use of circumference-derived diameter resulted in lower incidence of PVAR. The findings of this study may be independent of the imaging modality and may therefore also apply to computed tomography-based aortic annulus measurements, but this needs to be further investigated.
BACKGROUND: The use of transcatheter aortic valve replacement (TAVR) is increasing worldwide. We present our 6-year experience using three-dimensional (3D) transesophageal echocardiography (TEE) and investigate whether different sizing methods of the aortic annulus lead to different prosthesis size that may impact outcome. METHODS: We investigated 262 patients who underwent TAVR and had 3D TEE data sets of the aortic annulus. We have used the area-derived diameter (Darea = 2(area/π)) and the circumference-derived diameter (Dcirc = Circumference/π) to size the prosthesis in separate populations in different time periods. RESULTS: The Dcirc method is correlated with lower incidence of paravalvular aortic regurgitation (PVAR; odds ratio = 0.44, 95% confidence interval, 0.23-0.85; P = .015). Other factors associated with PVAR were the cover index, area-mismatch index, and circumference-mismatch index. Retrospectively, for the purposes of the study, we used the Edwards-Sapien 3 Valve 3D sizing guide in all patients, to predict the hypothetical valve size with each method. In the whole population, the calculated Dcirc was higher in all cases (Dcirc = 23.4 ± 2.3 mm vs Darea = 22.9 ± 2.3 mm; P < .001). The two methods had good agreement in predicting the valve size (kappa = 0.600). In total, 192 (73.3%) patients were assigned for the same prosthesis size, whereas 70 (26.7%) would be eligible for a different size, of which 44 (16.7%) would definitely have had a different valve implanted. CONCLUSION: Using the aortic annulus area or circumference to calculate the annular diameter provides different values. Comparing the two methods, a different prosthesis size could have been implanted in 26.7% of patients. In our series the use of circumference-derived diameter resulted in lower incidence of PVAR. The findings of this study may be independent of the imaging modality and may therefore also apply to computed tomography-based aortic annulus measurements, but this needs to be further investigated.
Authors: Sandro Queirós; Pedro Morais; Wolfgang Fehske; Alexandros Papachristidis; Jens-Uwe Voigt; Jaime C Fonseca; Jan D'hooge; João L Vilaça Journal: Int J Cardiovasc Imaging Date: 2019-01-30 Impact factor: 2.357