Abstract 13245: Three-Dimensional Imaging of Aortic Valve Geometry Prior to Tavi Procedures: Comparison Between 3d-Transesophageal Echocardiography and Contrast Enhanced Computed Tomography

Abstract

Background: Contrast enhanced cardiac computed tomography (cCT) is considered the gold standard for the assessment of aortic valve (AV) anatomy, but inherits some important limitations. Three-dimensional transesophageal echocardiography (3DTEE) allows fast and accurate offline reconstruction of AV-geometry. IIn this study we aimed to determine the correlation of cCT and 3DTEE measurements of AV geometry.

Methods: Consecutive patients underwent 2D- and 3DTEE and multislice cCT with offline reconstruction of AV geometry prior to TAVI. Prosthesis-size selection was based on cCT measurements. First, 3DTEE and cCT analysis were performed simultaneously in 10 patients to adjust determinants of AV geometry. In a second step the observers of cCT images were blinded to the results of 3DTEE studies .

Results: 64 consecutive patients (age 80.2±6.0 years, 46% male, left-ventricular ejection-fraction 49.3±14.6%, LogEuroSCORE 26.2±16.6% [4-67%], STS-mortality-score 8.2±5.2%) undergoing TAVI with the Medtronic CoreValve prosthesis underwent blinded image analysis. Mean perimeters were highly significant correlated (3DTEE, 7.6±0.86cm; cCT, 7.7±0.84cm, r=0.91, P<0.001; figure1). 3D-TEE-AV-diameters correlated significantly with cCT measurements (minimal diameters: 2.1±0.25cm, 2.1±0.27cm; r=0.8, P<0.001; maximal diameter: 2.7±0.31cm, 2.7±0.26cm; r=0.88, P<0.001). 3D-imaging guided TAVI resulted in a significant decrease in AV-stenosis defining parameters with moderate periprosthetic AR in only 2.4% of patients. All 2D-measurements from TEE and fluoroscopy were significantly different to results from 3D-TEE and cCT.

Conclusion: 3D-reconstruction of the aortic-valve-anatomy is of crucial importance for the TAVI procedure and not comparable to 2D-measurements. 3D-transesophageal echocardiography allows reliable assessment of aortic-valve geometry which is highly comparable to cCT.