Abstract 17462: Computer Tomography Prior to Transcatheter Aortic Valve Implantation: the Challenege With Large Aortic Annular Size
Background: Computer tomography (CT) is widely accepted as the standard for sizing the aortic valve annulus during evaluation for transcatheter aortic valve implantation (TAVI). The reliability of CT has however been questioned in patients with large annulus. We compared CT with direct intraoperative measurements of annular size among patients that were rejected for TAVI due to a large aortic valve annulus who underwent high-risk surgical aortic valve replacement (SAVR).
Methods: Retrospective study based on TAVI registry of single tertiary care center. Preoperative CT scan in all patients determined the aortic annular diameter by 2 methods: 1. Average of long and short aortic annulus diameters 2. diameter derived from measured perimeter. Intraoperative sizing of the aortic annulus was done by measuring the circumference using a sizing balloon while the aorta was dissected during SAVR. Diameters were compared using paired T-test.
Results: Among 451 patients evaluated for TAVI, 22 (4.9%) were finally turned down due to large aortic valve annulus on CT. Of those turned down 10 underwent SAVR with no death 30 days after surgery. Compared to direct intraoperative measurement CT overestimated the annular size by 3.75mm +1.78 when mean of long and short diameters was used; and overestimated by 4.57mm +1.79 when using perimeter; p-value <0.0001 for both. Based on the annular sizes measured intraoperatively, all patients who had high-risk SAVR in retrospect could have been eligible for TAVI.
Conclusions: CT overestimates aortic valve annular size in patients with large annulus which may incorrectly disqualify some patients for TAVI.
Author Disclosures: V.K. Puppala: None. T. Nfor: None. J. Khitha: None. P. Nijjar: None. D.P. O’Hair: None. A. Kirby: None. T.K. Bajwa: None.
- © 2014 by American Heart Association, Inc.