Intentional Computed Tomography-based Oversizing in Balloon-expandable Transcatheter Aortic Valve Implantation - Incidence of Paravalvular Regurgitation and Post-deployment Geometry

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Ziele: To evaluate the outcome in regard to paravalvular regurgitation and post-deployment geometry of intentional computed tomography (CT)-based oversizing of Transcatheter Heart Valves (THV) in Transcatheter Aortic Valve Implantation (TAVI) using pre- and post-deployment dual-source CT. Methode: Seventy-nine patients with severe aortic stenosis (mean age 81 ± 8 years, mean aortic valve area 0.69 ± 0.18 cm2) underwent retrospectively gated DSCT for THV sizing prior to TAVI. Aortic annulus dimensions were quantified by means of planimetry and area-derived diameter calculation (calculated average annulus diameter, CAAD = 2 x (area/pi) at the level of the basal attachment points of the aortic cusps during systole. THV selection was CAAD-based (EdwardSAPIEN XT 23 mm THV for CAAD <22mm, 26mm THV for CAAD 22–25mm, 29mm THV for CAAD >25 mm). Post-deployment CT was performed in 70 patients. Stent-unfolding was assessed planimetrically at the inlet, outlet and level of the native annulus. Relative oversizing and relative changes in annulus dimensions were calculated. Ergebnis: Average pre-deployment CAAD was 24.1 ± 1.7 mm, average post-deployment CAAD was 23.9 ± 1.5 mm (p = n.s.). Average relative change in CAAD was -0.4 ± 3.4%. Mean relative oversizing was 9.2 ± 4.8%. Mean diameter at the THV outlet was significantly larger than at the THV inlet (24.5 ± 1.7 mm vs. 23.9 ± 1.6 mm, p<0.001). Mild to moderate paravalvular regurgitation was observed in 6 patients (9%). There was no moderate or severe paravalvular regurgitation or uncontained aortic root rupture. Schlussfolgerung: Intentional oversizing of the THV based on an area-derived annulus diameter in CT and an adapted incremental sizing scheme is safe and is associated with a lower incidence of relevant paravalvular regurgitation, as compared to published landmark trials with echocardiography-based THV-sizing.