CT is the main component of the global exposure to ionizing radiation for patients benefiting from a trans-femoral TAVR

Abstract

X-rays are widely used for the TAVR realization, for the pre-TAVR assessment (coronary angiography ± PCI and computed tomography), and sometimes in the aftermath of the intervention (electrophysiology study, pacemaker implantation). TAVR currently becomes an alternative to surgical valve replacement for patients at intermediate risk, a population that is likely to experience an increase of the radiation-induced cancer risk following TAVR. The main objective of our study was therefore to evaluate the overall exposure to ionizing radiation for patients benefiting from a trans-femoral TAVR. All patients who underwent trans-femoral TAVR for a symptomatic aortic stenosis in our centre over a 26 months period were included. Dosimetric indicators (i.e. dose area product or dose length product) of pre-procedural coronary angiography and computed tomography, TAVR procedure, and any post-procedural interventions (electrophysiology study and/or pacemaker implantation) were collected and converted into an effective dose. The primary endpoint was the cumulative effective dose, calculated by summing effective doses received during the TAVR procedure and during pre- and post-procedural irradiating exams. One hundred and ninteen trans-femoral TAVR procedures were included, and the mean cumulative effective dose was 37.3 mSv. When only three procedures were necessary (71% of the population), 75% of the overall effective dose was from the computed tomography, while only 11% of this dose came from the TAVR procedure itself and 14% came from the coronary angiogram ( Table 1 , Fig. 1 ). Overall exposure to ionizing radiation for patients benefiting from a trans-femoral TAVR seemed acceptable, and the majority of the overall effective dose was from the computed tomography.