Jeremy Ben-Shoshan1, Hind Alosaimi2, Pascal Thériault Lauzier2, Michele Pighi3, Yeela Talmor-Barkan4, Pavel Overtchouk2, Giuseppe Martucci2, Marco Spaziano2, Ariel Finkelstein5, Hemal Gada6, Nicolo Piazza7. 1. McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel. 2. McGill University Health Centre, McGill University, Montreal, Quebec, Canada. 3. Division of Cardiology, University of Verona, Verona, Italy. 4. Rabin Medical Center, Petah-Tikva, Tel-Aviv University, Tel-Aviv, Israel. 5. Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel. 6. UPMC PinnacleHealth Cardiovascular Institute, UPMC PinnacleHealth, Harrisburg, Pennsylvania, USA. 7. McGill University Health Centre, McGill University, Montreal, Quebec, Canada. Electronic address: nicolopiazza@mac.com.
Abstract
OBJECTIVES: The purpose of this study was to assess the concordance between transcatheter aortic valve implantation angles generated by the "double S-curve" and "cusp-overlap" techniques. BACKGROUND: The "double S-curve" and "cusp-overlap" methods aim to define optimal fluoroscopic projections for transcatheter aortic valve replacement (TAVR) with a self-expandable device. METHODS: The study included 100 consecutive patients undergoing TAVR with self-expanding device planned by multidetector computed tomography. TAVR was performed using the double S-curve model, as a view in which both the aortic valve annulus and delivery catheter planes are displayed perpendicularly on fluoroscopy. Optimal projection according to the cusp-overlap technique was retrospectively generated by overlapping the right and left cups on the multidetector computed tomography annular plane. The angular difference between methods was assessed in spherical 3 dimensions and on the left and right anterior oblique (RAO) and cranial and caudal (CAU) axes. RESULTS: The double S-curve and cusp-overlap methods provided views located in the same quadrant, mostly the RAO and CAU, in 92% of patients with a median 3-dimensional angular difference of 10.0° (interquartile range: 5.5° to 17.9°). The 3-dimensional deviation between the average angulation obtained by each method was not statistically significant (1.49°; p = 0.349). No significant differences in average coordinates were noted between the double S-curve and cusp-overlap methods (RAO: 14.7 ± 15.2 vs. 12.9 ± 12.5; p = 0.36; and CAU: 27.0 ± 9.4 vs. 26.9 ± 10.4; p = 0.90). TAVR using the double S-curve was associated with 98% device success, low complication rate, and absence of moderate-to-severe paravalvular leak. CONCLUSIONS: The double S-curve and cusp-overlap methods provide comparable TAVR projections, mostly RAO and CAU. TAVR using the double S-curve model is associated with a high rate of device success and low rate of procedural complications.
OBJECTIVES: The purpose of this study was to assess the concordance between transcatheter aortic valve implantation angles generated by the "double S-curve" and "cusp-overlap" techniques. BACKGROUND: The "double S-curve" and "cusp-overlap" methods aim to define optimal fluoroscopic projections for transcatheter aortic valve replacement (TAVR) with a self-expandable device. METHODS: The study included 100 consecutive patients undergoing TAVR with self-expanding device planned by multidetector computed tomography. TAVR was performed using the double S-curve model, as a view in which both the aortic valve annulus and delivery catheter planes are displayed perpendicularly on fluoroscopy. Optimal projection according to the cusp-overlap technique was retrospectively generated by overlapping the right and left cups on the multidetector computed tomography annular plane. The angular difference between methods was assessed in spherical 3 dimensions and on the left and right anterior oblique (RAO) and cranial and caudal (CAU) axes. RESULTS: The double S-curve and cusp-overlap methods provided views located in the same quadrant, mostly the RAO and CAU, in 92% of patients with a median 3-dimensional angular difference of 10.0° (interquartile range: 5.5° to 17.9°). The 3-dimensional deviation between the average angulation obtained by each method was not statistically significant (1.49°; p = 0.349). No significant differences in average coordinates were noted between the double S-curve and cusp-overlap methods (RAO: 14.7 ± 15.2 vs. 12.9 ± 12.5; p = 0.36; and CAU: 27.0 ± 9.4 vs. 26.9 ± 10.4; p = 0.90). TAVR using the double S-curve was associated with 98% device success, low complication rate, and absence of moderate-to-severe paravalvular leak. CONCLUSIONS: The double S-curve and cusp-overlap methods provide comparable TAVR projections, mostly RAO and CAU. TAVR using the double S-curve model is associated with a high rate of device success and low rate of procedural complications.
Authors: Oliver Maier; Kerstin Piayda; Stephan Binnebößel; Nora Berisha; Shazia Afzal; Amin Polzin; Kathrin Klein; Ralf Westenfeld; Patrick Horn; Christian Jung; Malte Kelm; Verena Veulemans; Tobias Zeus Journal: Front Cardiovasc Med Date: 2022-08-31