1. Evaluation of a Low-Dose Radiation Protocol During Transcatheter Aortic Valve Implantation.
- Author
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Michel JM, Hashorva D, Kretschmer A, Alvarez-Covarrubias HA, Mayr NP, Pellegrini C, Rheude T, Frangieh AH, Giacoppo D, Kastrati A, Schunkert H, Xhepa E, Joner M, and Kasel AM
- Subjects
- Aged, Aged, 80 and over, Aortic Valve Stenosis diagnosis, Dose-Response Relationship, Radiation, Female, Humans, Male, Prognosis, Retrospective Studies, Risk Factors, Aortic Valve surgery, Aortic Valve Stenosis surgery, Fluoroscopy methods, Radiation Injuries prevention & control, Surgery, Computer-Assisted methods, Transcatheter Aortic Valve Replacement methods
- Abstract
We aimed to evaluate the efficacy and safety of a low-dose imaging protocol to reduce intraprocedural radiation during transcatheter aortic valve implantation (TAVI). Observational analysis: 802 transfemoral TAVI patients receiving balloon-expandable devices ≥23 mm at a high-volume centre. After propensity score matching, a standard-dose group (SD, n = 333) treated between January 2014 and February 2016 was compared with a low-dose group (LD, n = 333) treated between August 2017 and March 2019 after departmental uptake of a low-dose imaging protocol (reduced field size, high table height, use of "fluoro save," 3.75 frames/second acquisition, increased filtering). Primary end point was dose-area product (DAP). Secondary safety end points were VARC-2 device success and a composite of in-hospital complications. The LD protocol was associated with lower DAP (4.64 [2.93, 8.42] vs 22.73 [12.31, 34.58] Gy⋅cm
2 , p <0.001) and fluoroscopy time (10.4 [8.1, 13.9] vs 11.5 [9.1, 15.3] minutes, p = 0.001). Contrast use was higher in the LD group (LD 110 [94, 130] vs SD 100 [80, 135] milliliters, p = 0.042). Device success (LD 88.3% vs SD 91.3%, p = 0.25), and the composite end point (LD 8.1% vs SD 11.4%, p = 0.19) were similar. In multivariate analysis, the low-dose protocol was associated with a 19.8 Gy⋅cm2 reduction in procedural DAP (p <0.001). In conclusion, compared with standard imaging, a low-dose protocol for TAVI significantly reduced radiation dose without compromising outcomes., Competing Interests: Disclosures This study was performed without external or industry funding. Dr. Michel has received honoraria from Edwards Lifesciences. Dr. Kasel is a consultant and proctor for Edwards Lifesciences. Dr. Frangieh is a consultant and proctor for Edwards Lifesciences. The remaining authors report no disclosures., (Copyright © 2020 Elsevier Inc. All rights reserved.)- Published
- 2021
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