Abstract
BackgroundOptimal projection is essential for valve deployment during transcatheter aortic valve implantation (TAVI). The purpose of this study was to propose an approach to predict optimal projection in TAVI candidates with different aortic valve anatomies.Methods331 patients undergoing self-expanding TAVI were included and the so-called non-coronary cusp (NCC)-parallel technique was utilized, which generated the predicted projection by connecting NCC commissures on the transverse plane on the pre-procedural computed tomography images.Results37.8% of the study cohort were bicuspid aortic valve (BAV) patients. Around 80% of both NCC-parallel views and final views were in the right anterior oblique (RAO) and caudal (CAU) quadrant. There was less than 5° change required from the NCC-parallel view to the final implanted view in 79% of tricuspid aortic valve (TAV) patients but only in 27% (13/48) of type 0 BAV patients with coronary arteries originated from the different cusps. After excluding the above mentioned BAV patients, 62.3% (48/77) of BAV patients needed less than 5° change to achieve optimal projection and only in 8 patients, the angular change was larger than 10° in either left/right anterior oblique or cranial/caudal direction.ConclusionsThe NCC-parallel technique provides reliable prediction for optimal projection in self-expanding TAVI in all TAV and most BAV patients, with a vast majority of views in the RAO and CAU quadrant.
Highlights
Optimal projection is essential for valve deployment during transcatheter aortic valve implantation (TAVI)
In the expert consensus from the Society of Cardiovascular Computed Tomography (SCCT) focusing on CT imaging in TAVI, it is strongly recommended that prediction of optimal projection based on pre-procedural multislice computed tomography (MSCT) be provided for each individual patient [2], which helps operators find the optimal views quickly during the procedure without performing multiple aortographies [3,4,5]
It is highly possible that the catheter of the self-expanding device is not aligned in the 3-cusp view during TAVI procedure, resulting in a period of time to search for another left anterior oblique (LAO) view to remove the parallax to the catheter
Summary
Optimal projection is essential for valve deployment during transcatheter aortic valve implantation (TAVI). The purpose of this study was to propose an approach to predict optimal projection in TAVI candidates with different aortic valve anatomies. Optimal projection views are critical to transcatheter aortic valve implantation (TAVI) procedures during transcatheter heart valve (THV) deployment, in order to eliminate the parallax of both the annulus and delivery catheter, which is of vital importance to achieve adequate perception of implantation depth and reduced risk of. Wang et al BMC Cardiovascular Disorders (2021) 21:590 cusp (LCC) is a typical and commonly used CT-based projection view [6]. The RCC and LCC hinge points would be overlapped, while the NCC would be isolated at the opposite annulus border. The optimal projection for BAV patients is warranted to achieve satisfying clinical results in this cohort
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