Abstract 17760: Safety and Reliability of Low Dose Contrast CT Angiography in Preoperative Evaluation of Renal Dysfunction Patients Undergoing Transcatheter Aortic Valve Replacement
Introduction: Cardiac and peripheral CT Angiography (CTA) is required for pre-operative evaluation of transcatheter aortic valve replacement (TAVR) in high risk patients who often have renal dysfunction. Standard doses of IV contrast may exaggerate renal dysfunction which affects survival in TAVR patients. The purpose of this study is to evaluate safety and diagnostic accuracy of low dose contrast (LDC) for both pre-operative cardiac and peripheral CTA assessment compared to standard dose contrast (SDC).
Methods: In 130 patients who underwent TAVR at a single institution during 2012 and 2013, SDC (≥60 ml of Omnipaque) was given to 83 patients with eGFR>40 and LDC (<60 ml) was given to 47 patients with eGFR <40. Image quality of iliofemoral vessels was assessed by 3 radiologists, blinded to contrast dose, on a scale of 1-4 (1: poor; 2: fair; 3: good; 4:excellent). Accuracy of aortic annular measurements was evaluated using outcomes of TAVR (paravalvular aortic regurgitation [PVAR], mortality, and aortic root rupture). Intraobserver variability was assessed to evaluate reproducibility of the annular measurements.
Results: LDC group received 46.17±7.95 ml and SDC group 65.66 ±10.02 ml of contrast (p<0.01). There was no statistical difference among the 3 radiologists on the image quality of iliofemoral vessels in the 2 groups (3.73 vs. 3.79, p=NS). No intraobserver difference for aortic annular area measurements were noted between 2 groups (1.4±4.6 vs. 1.5±4.7 mm2, p=NS ). There was no significant difference in change in creatinine between LDC and SDC groups (0.02±0.23 vs. -0.03±0.34, p = NS) or in eGFR (- 4.26 ±11.95 vs. 2.14±16.24, p = NS) after CTA. All patients underwent successful TAVR implantation with no procedural death or annular rupture. There was no difference in 30 day mortality between LDC and SDC groups (4.3% vs. 2.4%, p = NS). There was no severe PVAR in either group. At 1 month, there was no difference in moderate PVAR between LDC and SDC (5.55% vs.7.25%, p= NS) or in mild PVAR (20% vs. 23%, p= NS).
Conclusion: Low dose contrast for cardiac and peripheral CTA (40-60 ml) in one scan is safe and reliable for pre-TAVR evaluation in patients with significantly impaired renal function.
Author Disclosures: C. Chu: None. V. Spektor: None. M. Sadler: None. S. Kiumehr: None. V. Malik: None. P. Panfile: None. M. Russo: None. B. Haik: None. P. Burn: None. M. Cohen: None. C. Chen: None.
- © 2014 by American Heart Association, Inc.