title: 3-dimensional aortic annular assessment by multidetector computed tomography predicts moderate or severe paravalvular regurgitation after transcatheter aortic valve replacement: a multicenter retrospective analysis.
abstract: OBJECTIVE
  This study sought to analyze multidetector computed tomography (MDCT) 3-dimensional aortic annular dimensions for the prediction of paravalvular aortic regurgitation (PAR) following transcatheter aortic valve replacement (TAVR).
  
  
  BACKGROUND
  Moderate or severe PAR after TAVR is associated with increased morbidity and mortality.
  
  
  METHODS
  A total of 109 consecutive patients underwent MDCT pre-TAVR with a balloon expandable aortic valve. Differences between transcatheter heart valve (THV) size and MDCT measures of annular size (mean diameter, area, and circumference) were analyzed concerning prediction of PAR. Patients with THV malposition (n = 7) were excluded. In 50 patients, MDCT was repeated after TAVR to assess THV eccentricity (1 - short diameter/long diameter) and expansion (MDCT measured THV area/nominal THV area).
  
  
  RESULTS
  Moderate or severe PAR (13 of 102) was associated with THV undersizing (THV diameter - mean diameter = -0.7 ± 1.4 mm vs. 0.9 ± 1.8 mm for trivial to mild PAR, p < 0.01). The difference between THV size and MDCT annular size was predictive of PAR (mean diameter: area under the curve [AUC]: 0.81, 95% confidence interval [CI]: 0.68 to 0.88; area: AUC: 0.80, 95% CI: 0.65 to 0.90; circumference: AUC: 0.76, 95% CI: 0.59 to 0.91). Annular eccentricity was not associated with PAR (AUC: 0.58, 95% CI: 0.46 to 0.75). We found that 35.3% (36 of 102) and 45.1% (46 of 102) of THVs were undersized relative to the MDCT mean diameter and area, respectively. THV oversizing relative to the annular area was not associated with THV eccentricity or underexpansion (oversized vs. undersized THVs; expansion: 102.7 ± 5.3% vs. 106.1 ± 5.6%, p = 0.03; eccentricity: median: 1.7% [interquartile range: 1.4% to 3.0%] vs. 1.7% [interquartile range: 1.1% to 2.7%], p = 0.28).
  
  
  CONCLUSIONS
  MDCT-derived 3-dimensional aortic annular measurements are predictive of moderate or severe PAR following TAVR. Oversizing of THVs may reduce the risk of moderate or severe PAR.
authors.affiliation: Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Willson
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.forename: Troy M
authors.initials: TM
authors.lastname: Labounty
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.forename: Robert
authors.initials: R
authors.lastname: Moss
authors.forename: Miriam
authors.initials: M
authors.lastname: Wheeler
authors.forename: Christopher
authors.initials: C
authors.lastname: Thompson
authors.forename: James K
authors.initials: JK
authors.lastname: Min
authors.forename: Ronen
authors.initials: R
authors.lastname: Gurvitch
authors.forename: Bjarne L
authors.initials: BL
authors.lastname: Norgaard
authors.forename: Cameron J
authors.initials: CJ
authors.lastname: Hague
authors.forename: Stefan
authors.initials: S
authors.lastname: Toggweiler
authors.forename: Ronald
authors.initials: R
authors.lastname: Binder
authors.forename: Melanie
authors.initials: M
authors.lastname: Freeman
authors.forename: Rohan
authors.initials: R
authors.lastname: Poulter
authors.forename: Steen
authors.initials: S
authors.lastname: Poulsen
authors.forename: David A
authors.initials: DA
authors.lastname: Wood
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000517:prevention & control; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome