Abstract 16485: Msct Guided Tavi Sizing Approach Using the Sapiens Xt Valve: Clinical and Functional Outcome and Device Geometry in Dependence of Different Degrees of Oversizing
Aims Pre-procedural device sizing is a critical step during the TAVI procedure using the Edwards-Sapien trans-catheter-aortic-valve (ESTV). The current standard for pre procedural annulus sizing is transesophageal echocardiography (TEE) although this method does not take into account its oval anatomy. We therefore assessed clinical and functional outcome of a 3-dimensional MSCT guided sizing approach and also determined prosthesis geometry after this approach using MSCT in a subset of 30 patients.
Methods TAVI-size-selection was done using MSCT-annulus cross-sectional-area (CSA) measurements in 107 patients, so that the outer nominal prosthesis-CSA always exceeded the annulus-CSA.
Results Intraprocedural and 30-day all-cause mortality was 1.8% and 6.5% respectively. The rate of > mild post-procedural AR (PAR) was 7.6%. Average device expansion-and circularity-index of the ESTV was 95% and 97%, with an almost complete circular shape (index>90%) in all patients. Over-sizing of the device by > 25% in relation to annulus-CSA was associated with a zero rate of > mild PAR compared to over sizing by<15% (0% vs. 16.2%, p<0.007) but also with a trend of a higher likelihood for post-procedural need of permanent pacemakers (5.2% vs. 16.6%, p<0.23). Pre- procedural TEE-measurements systematically underestimated annulus dimensions and would have lead to the selection of smaller sized devices in 35% of patients.
Conclusions MSCT guided ESTV-device sizing is associated with almost complete and symmetric expansion and with lower than previously reported rates for PAR. Rigorous ESTV over sizing reduces the rate of PAR, is however associated with a higher risk of pacemaker implantations and emphasizes the need for more available prosthesis sizes.
- © 2012 by American Heart Association, Inc.