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Annular versus supra-annular sizing for transcatheter aortic valve replacement in bicuspid aortic valve disease.
- Source :
-
Journal of cardiovascular computed tomography [J Cardiovasc Comput Tomogr] 2020 Sep - Oct; Vol. 14 (5), pp. 407-413. Date of Electronic Publication: 2020 Jan 31. - Publication Year :
- 2020
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Abstract
- Background: CT measurement of supra-annular area (SA) has been proposed as an alternative to annular area (AA) for sizing of trancatheter valves in biscuspid aortic valves (BAV). This study examines the reproducibility of SA and AA measurements and their potential impact on downstream transcatheter heart valve sizing and clinical outcomes.<br />Methods: 44 consecutive patients (mean age: 73 ± 15 years, 57% male) undergoing CTA with subsequent SAPIEN 3 valve insertion for severe bicuspid aortic stenosis (AS) were included. AA was measured at the basal ring. SA was measured by generating a circle defined by the intercommisural distance. AA and SA were measured by 2 independent observers. Baseline characteristics, TAVR procedural data, and discharge echocardiography data were collected.<br />Results: The SA was significantly larger than the AA (562 ± 146mm2 vs. 518 ± 112mm2,p = 0.013). Interobserver agreement was high using both techniques (ICC AA = 0.98,p < 0.001; SA = 0.80,p < 0.001), but with narrower limits of agreement with AA measurements (mean difference (limits of agreement): AA = -3mm2 (22; 19), SA = -16mm2 (-92; 76)). AA-based device sizing demonstrated substantial agreement with final valve inserted (κ = 0.72,p < 0.001), while SA demonstrated fair agreement (κ = 0.40,p < 0.001). There was no difference in post TAVR gradients, paravalvular leakage or valve success between patients with concordant sizing between AA and SA, and those in whom SA would have suggested an alternate valve size.<br />Conclusions: Supra-annular sizing is less reproducible than annular sizing, with no difference in procedural complication rates in patients in whom supra-annular sizing would have altered the device size used. These results suggest no role for supra-annular sizing in current clinical practice.<br />Competing Interests: Declaration of competing interest Drs. Webb, Blanke, Leipsic, and Wood are consultants to and have received research support from Edwards Life-sciences. Dr. Blanke has served as a consultant for Neovasc, Tendyne, and Circle Cardiovascular Imaging. Dr. Leipsic has received support through his institutional core laboratory from Edwards, Medtronic, Abbott, and Neovasc; and has served as a consultant for and has stock options in CIRCL CVI and Heartflow. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.<br /> (Copyright © 2020 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Aortic Valve diagnostic imaging
Aortic Valve physiopathology
Aortic Valve surgery
Aortic Valve Stenosis diagnostic imaging
Aortic Valve Stenosis physiopathology
Bicuspid Aortic Valve Disease
Computed Tomography Angiography
Coronary Angiography
Echocardiography
Female
Heart Valve Diseases diagnostic imaging
Heart Valve Diseases physiopathology
Humans
Male
Middle Aged
Multidetector Computed Tomography
Predictive Value of Tests
Retrospective Studies
Severity of Illness Index
Transcatheter Aortic Valve Replacement adverse effects
Treatment Outcome
Aortic Valve abnormalities
Aortic Valve Stenosis surgery
Heart Valve Diseases surgery
Heart Valve Prosthesis
Prosthesis Design
Transcatheter Aortic Valve Replacement instrumentation
Subjects
Details
- Language :
- English
- ISSN :
- 1876-861X
- Volume :
- 14
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of cardiovascular computed tomography
- Publication Type :
- Academic Journal
- Accession number :
- 32029384
- Full Text :
- https://doi.org/10.1016/j.jcct.2020.01.008