Abstract
Background: Multidetector computed tomography (MDCT) has been increasingly employed for valve sizing before TAVI as it enables a 3-dimensional analysis of the aortic annulus. Therefore, the aim of this study was to retrospectively analyze if image analysis has an influence on outcomes of patients undergoing TAVI. Methods: A total of 186 consecutive pre-TAVI-MDCTs of patients treated in 2010 and 2011 at our institution when the minimum/maximum diameter of the aortic annulus as determined by MDCT was used for valve sizing, were retrospectively analyzed with the image analysis software (3-mensio Medical Imaging) in a blinded fashion. Parameters used for calculation of the aortic annulus size included annulus area, diameter and perimeter. Valve sizes were determined as recommended by the respective manufacturer based on these parameters. Results: Patients either received the Edwards Sapien (n = 91), the Medtronic Corevalve (n = 84) or the Medtronic Engager (n = 11). In 130 patients (69.9%/Group A) image analysis recommended the same valve size that was actually implanted. However, in 29 patients (15.6%/Group B) image analysis revealed a larger valve size and in 27 patients (14.5%/Group C) a smaller size was suggested. Patients of group B showed a seven-fold higher rate of aortic regurgitation (AR)≥2 (n = 6/29) compared to group A (n = 4/130;p = 0.001) whereas group C did not show a higher incidence of conduction disorders (p = 0.5). Interestingly, there was no difference in 30 day mortality (4.6%(A), 3.4%(B), 7.4%(C) p = 0.76) and 1-year mortality between all three groups (27.5%(A), 17.2%(B), 30.4%(C); p = 0.21). Conclusion: Retrospective image analysis of pre-TAVI-MDCTs by a dedicated software revealed a different valve size in about one third of the patient cohort. Patients with an undersized valve had a seven fold higher risk for moderate AR but this did not translate into a reduced 1 year survival of the respective patients.
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