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Assessment of aortic annulus dimensions for Edwards SAPIEN Transapical Heart Valve implantation by computed tomography: calculating average diameter using a virtual ring method.
- Source :
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European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery [Eur J Cardiothorac Surg] 2010 Dec; Vol. 38 (6), pp. 750-8. Date of Electronic Publication: 2010 May 15. - Publication Year :
- 2010
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Abstract
- Objective: Accurate preoperative assessment of the aortic annulus dimensions is critical in patients undergoing transcatheter aortic valve implantation (TAVI) for severe AS. Using multislice computed tomography (MSCT), we evaluated a novel approach to quantify aortic annulus dimensions using cross-sectional area (CSA) assessment and average diameter calculation compared with the commonly applied electronic caliper measurements in patients undergoing transapical implantation of the Edwards SAPIEN Transcatheter Heart Valve.<br />Methods: Seventy-one patients underwent pre-TAVI MSCT with the following dimensions assessed at the level of the most basal attachment points of all three aortic cusps joined by a virtual ring: CSA, calculated average annulus diameter (CAAD), and minimal, maximum, sagittal and coronal diameters. Measurements were compared with post-TAVI MSCT data sets at the level of the ventricular stent ending in 24 patients. Pre-TAVI measurements were compared to those taken post-TAVI. Eligibility to balloon-expandable TAVI was evaluated based on the different measurements.<br />Results: The Edwards SAPIEN valve (23 mm, n=8; 26 mm, n=16) was implanted 2.1±1.1 mm below the non-coronary sinus. Pre-TAVI CAAD was 23.0±1.6 mm; post-TAVI CAAD was 23.0±1.1 mm. Post-TAVI CSA was circular in 18 patients (75%) and ovoid in six (25%). Pre- and post-TAVI assessment showed strong correlation for CSA and CAAD (r=0.835, p<0.001; r=0.841, p<0.001, respectively). Minimal, maximum, coronal and sagittal dimension correlated weakly between pre- and post-TAVI measurements (r=0.435-0.632, p=0.001-0.034).<br />Conclusion: Pre-TAVI CSA assessment and average diameter calculation using a virtual ring method is able to predict the post-interventional configuration of the annulus after balloon-expandable TAVI. We regard this approach as the best-available method to select the appropriate prosthesis size for balloon-expandable TAVI. Specific MSCT-based sizing recommendations should be developed.<br /> (Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Aortic Valve diagnostic imaging
Aortic Valve pathology
Aortic Valve Insufficiency etiology
Aortic Valve Stenosis diagnostic imaging
Aortic Valve Stenosis pathology
Echocardiography, Transesophageal methods
Female
Heart Valve Prosthesis
Humans
Male
Observer Variation
Prosthesis Design
Reproducibility of Results
Tomography, X-Ray Computed methods
Aortic Valve Stenosis surgery
Heart Valve Prosthesis Implantation methods
Subjects
Details
- Language :
- English
- ISSN :
- 1873-734X
- Volume :
- 38
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 20472458
- Full Text :
- https://doi.org/10.1016/j.ejcts.2010.03.039