Abstract
Incorrect prosthesis size has direct impact on patient outcome after transcatheter aortic valve implantation (TAVI) procedure. Currently, annular diameter, area or perimeter may be used for prosthesis size selection. The aim was to evaluate whether the use different annular dimensions would result in the selection of different prosthesis sizes, when assessed in the same TAVI-candidate during the same phase of a cardiac cycle. Fifty consecutive TAVI-candidates underwent retrospectively ECG-gated computed tomography angiography (CTA). Aortic root dimensions were assessed in the 20% phase of the R–R interval. Annular short diameter, perimeter and area were used to select the prosthesis size, based on the industry recommendations for a self-expandable (Medtronic CoreValve; MCV) and balloon-expandable (Edwards Sapien XT Valve; ESV) valve. Complete agreement on selected prosthesis size amongst all three annular dimensions was observed in 62% (31/50; ESV) and 30% (15/50; MCV). Short aortic annulus measurement resulted in a smaller prosthesis size in 20% (10/50; ESV) and in 60% of cases (30/50; MCV) compared to the size suggested by both annular perimeter and area. In 18% (9/50; ESV) and 10% of cases (5/50; MCV) a larger prosthesis would have been selected based on annular perimeter compared to annular diameter and area. Prosthesis size derived from area was always in agreement with at least one other parameter in all cases. Aortic annulus area appears to be the most robust parameter for TAVI-prosthesis size selection, regardless of the specific prosthesis size. Short aortic annulus diameter may underestimate the prosthesis size, while use of annular perimeter may lead to size overestimation in some cases.
Highlights
Transcatheter aortic valve implantation (TAVI) is a minimally invasive and alternative treatment of severe symptomatic aortic stenosis, originally only indicated in patients with high surgical risk, who are not suitable for an openheart surgical aortic valve replacement [1,2,3]
Industry recommendations for transcatheter aortic valve size selection have been based on the annular diameter, which was assessed as the left ventricular outflow tract (LVOT) diameter in echocardiography [6]
We evaluate the Multidetector row computed tomography (MDCT) assessed short annular diameter, because it resembles the LVOT diameter assessed on the parasternal long axis view (PLAX) in echocardiography [6, 10] and corresponds the best with the diameter sizing thresholds in industry guidelines
Summary
Transcatheter aortic valve implantation (TAVI) is a minimally invasive and alternative treatment of severe symptomatic aortic stenosis, originally only indicated in patients with high surgical risk, who are not suitable for an openheart surgical aortic valve replacement [1,2,3]. To restrict from modification of industry recommendations in this study, we derive the TAVI prosthesis size directly from the measurement of annular area or perimeter, rather than from calculated effective diameters. To the best of our knowledge this is the first study to evaluate, whether the three aortic annulus dimensions stated in the industry guidelines can be used interchangeably for TAVI planning. To this aim, we have assessed the aortic annulus short diameter, area and perimeter in the same phase of the cardiac cycle in fifty consecutive TAVI-candidates undergoing MDCT and recorded the suggested prosthesis size for each annular measurement
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