Abstract 10327: Automated Quantitative Modeling of the Aortic Root by Real-Time 3D TEE Predicts Optimal Valve Size for TAVR Planning When Contrast CT is Contraindicated

Abstract

Background: While CT is the modality of choice for TAVR planning, contrast CT may be not be possible in those with renal dysfunction. We tested whether automated quantitative modeling of the aortic root by real-time 3D TEE (RT3D-TEE) was a useful alternative in these patients. Methods: 44 patients (76 ± 10 years old) with severe AS who could not have contrast CT for TAVR planning had RT3D TEE during TAVR procedure. The aortic root was modeled automatically using the previously validated eSie valves (Siemens, CA). From the dynamic model maximum, minimum and mean aortic annulus diameters, aortic annulus perimeter, and aortic annulus area were measured in mid/peak systole, whichever was larger. The predicted valve size based on these parameters was compared to the actual valve size used during TAVR (balloon and self-expanding valves). Results: The valve size predicted by automated quantitative RT3D-TEE had excellent correlation with the actual valve size (indexed by body surface area, r=0.96 for mean diameter, 0.94 for perimeter and area derived diameters, p < 0.0001, Figure-upper panel graph). The agreement (Kappa statistic) between actual valve size used and that predicted by RT3D-TEE was 0.82, 0.64 and 0.58, p < 0.0001 for mean diameter, and perimeter and area derived diameters (lower left table). The red dots in the graph in the upper panel show cases where there was discrepancy between 3-D TEE predicted and actual valve size used. Mean diameter had the fewest "underestimation" of the valve size vs. perimeter and area derived prediction. An example of quantitative aortic root modeling in a patient who had TAVR with a 31 mm self-expanding valve, with no PVL (lower right panel). Conclusion: Automated quantitative modeling of the aortic root by real-time 3-D TEE in severe AS is feasible, rapid and an excellent alternative to contrast CT when the latter is contraindicated, for TAVR planning. Mean annulus diameter measured by 3D-TEE seems to be the best predictor of the optimal valve size.