Abstract 20605: The Concept of “Effective Implant Area”: A Simple Method Beyond Annular Sizing to Optimize Valve Selection and Outcomes in Transcatheter Aortic Valve Replacement
Introduction: Degree of valve oversizing and calcification impact paravalvular aortic regurgitation (PAR) and aortic root rupture in TAVR, but no consistent method predicts both outcomes. Current valve sizing relies on 2D annular dimensions by CT or TEE yet does not account for severity and location of calcium in the aortic root complex.
Hypothesis: We propose the concept of "Effective Implant Area" (EIA) to incorporate aortic root calcification to optimize valve selection and outcomes in TAVR.
Methods: From 2/2013-6/2014, 35 out of 41 consecutive patients (age 83+/-8 years, 69% female) had valve sizing by CT then TAVR with Edwards Sapien valve (13 TF, 18 TA, 4 TAo). STS risk score averaged 7.5+/-3.3% and 80% patients were frail. 19 retrospective and 16 prospective comparison of annular area with the minimal supra-annular and left ventricular outflow track areas were made to devise an EIA. Combined with evaluation of aortic root calcium, valve size and degree of balloon filling for deployment were finalized. Follow-up was 100% complete.
Results: Procedural success was 100%; one had root rupture that retrospectively should have had a smaller valve by EIA (Table 1). Of 16 subsequent patients with EIA prospectively derived, 4 had significantly smaller EIA than annular areas due to calcification, resulting in selection of a smaller valve (Table 1). With EIA sizing, no further root rupture occurred, and 2 patients with moderate PAR without post dilatation improved to mild at discharge. At 30 days, 87% had none-trivial, 13% mild PAR; improved to 95% none-trivial, 5% mild PAR at 6 months and 100% none-trivial PAR at 1 year.
Conclusions: Determining "Effective Implant Area" is a simple yet reproducible method that accounts for aortic root calcification to optimize valve size in TAVR, minimizing PAR and root rupture risk. EIA should be routinely assessed in conjunction with annular area for valve sizing in all TAVR cases.
Author Disclosures: G.H. Tang: None. A. Tong: None. A. Shah: None. T. Dutta: None. M. Cohen: None. H. Ahmad: None. L. Cuomo: None. C. Undemir: None. S.L. Lansman: None.
- © 2014 by American Heart Association, Inc.