Abstract 12846: Impact of CT-Guided Bioprosthesis Sizing on Post-Procedural Aortic Regurgitation in Transcatheter Aortic Valve Implantation
Purpose: Measurement of the aortic annulus is crucial for appropriate valve sizing in transcatheter aortic valve implantation (TAVI). The main limitation of transesophageal echography (TEE) is that it measures only the sagital diameter, whereas the aortic annulus has an oval shape. The purpose of this study was to clarify the impact of CT-guided valve sizing on outcomes after TAVI.
Method: TAVI was performed in 337 consecutive cases in our institution. TEE-guided valve sizing was conducted in our early experience (n=228). CT-guided approach has been applied since 2010 (n=109). The CT-measured mean annulus diameter was calculated as: mDiam-CT = 2√(annulus surface/π). The outcomes of CT and TEE-guided strategy were compared.
Results: The CT group had lower Euroscore (20.6±10.8% vs 24.8±11.5%, p=0.002), higher eGFR (58.6±22.6 vs 49.8±24.2ml/min, p=0.002) and left ventricular ejection fraction (58.6±22.6 vs 49.8±24.2, p=0.002). TEE-measured annulus diameter (Diam-TEE) was similar (22.1±2.0 vs 21.8±1.8mm, p=0.155). In the CT group, the Diam-TEE was larger than the shortest CT diameter (22.1±2.0 vs 21.7±2.0mm, p=0.008), but smaller than mDiam-CT (23.4±2.0mm, p<0.001) and largest CT diameter (25.9±2.3mm, p<00001). The Edwards valve was used in 290 cases (23mm in 42%, 26mm 56% and 29mm 2%) and Corevalve in 47 (26mm in 26% and 29mm in 74%). Edwards valves were used similarly in both groups (84% vs 87%, p=0.547). The CT group had significantly larger valve size (25.8±2.1 vs 25.0±1.9mm, p<0.001) and larger valve/Diam-TEE ratio (1.17±0.08 vs 1.14±0.10mm, p=0.014) compared to TEE group. Although post dilatation was required similarly in both groups (12.7 vs 10.8%, p=0.506), the incidence of post-procedural AR ≥2 was decreased in CT group (19.1 vs 30.7%, p=0.031) without any increase in annulus rupture (0.9 vs 1.3%, p=0.750). Conversion to surgery was less often required in CT group (0% vs 3.5%, p=0.004), device success was improved (95.4 vs 85.0%, p=0.028) and 30-day death rate was lower (8.3 vs 18.0%, p=0.009) compared to TEE.
Conclusion: CT-guided strategy provides larger valve sizing compared to TEE with appropriate accuracy, resulting in a significantly lower incidence of post-procedural AR without any increase in annulus rupture and 30-day mortality.
- © 2011 by American Heart Association, Inc.