title: Benefits of high-pitch 128-slice dual-source computed tomography for planning of transcatheter aortic valve implantation.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment for high-risk and inoperable patients. Advanced multimodality imaging, including computed tomography (CT), plays a key role for optimized planning of TAVI.
  
  
  METHODS
  Forty-nine patients (25 women; age, 82.3±8.8 year) with severe aortic stenosis scheduled for TAVI were examined with 128-slice high-pitch dual-source prospective aortoiliac CT angiography (CTA). The 3-coronary-sinus-alignment (3-CSA) plane, comprising left and right anterior oblique and craniocaudal projection, was defined from three-dimensional volume-rendered technique data sets and compared with the intraoperative angiographic plane (deployment plane) used for device implantation. A tolerance level of ±5-degree deviation was acceptable. Volume of intraoperative iodine contrast agent was compared before and after the implementation of the 3-CSA plane estimation by CT.
  
  
  RESULTS
  All 49 patients underwent TAVI, during which 6 CoreValves (Medtronic, Minneapolis, MN) and 43 Sapien valves (Edwards Lifesciences, Irvine, CA) were successfully implanted using transapical (n=29), transfemoral (n=17), and transaxillary access (n=4). No severe complications occurred. In 47 patients (96%), CTA correctly predicted the 3-CSA plane used for device implantation. Mean left anterior oblique by CTA was 5.3±6.5 degrees and craniocaudal was -1.3±10.1 degrees. Mean left anterior oblique deviation between CTA and the intraoperative projection was 2.1±2.7 degrees and craniocaudal was 1.7±3.0 degrees. Ostium heights of the right and left coronary arteries were 12±1.9 and 12.9±3.3 mm. No over-stenting occurred in left coronary artery ostia of 8 mm or more. Contrast volume was reduced from 81.8±25.6 to 59.4±40.2 mL (p=0.05) when using 3-CSA plane estimation by CT for final prosthesis implantation plane.
  
  
  CONCLUSIONS
  Aortoiliac high-pitch 128-slice dual-source CT contributes to TAVI planning, including reliable prediction of the 3-CSA valve deployment plane, which saves contrast volume during the procedure and may facilitate correct valve placement.
authors.affiliation: Department of Radiology, Innsbruck Medical University, Innsbruck, Austria. fabian.plank@student.i-med.ac.at
authors.forename: Fabian
authors.initials: F
authors.lastname: Plank
authors.forename: Guy
authors.initials: G
authors.lastname: Friedrich
authors.forename: Thomas
authors.initials: T
authors.lastname: Bartel
authors.forename: Silvana
authors.initials: S
authors.lastname: Mueller
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Bonaros
authors.forename: Anneliese
authors.initials: A
authors.lastname: Heinz
authors.forename: Andrea
authors.initials: A
authors.lastname: Klauser
authors.forename: Fabiola
authors.initials: F
authors.lastname: Cartes-Zumelzu
authors.forename: Michael
authors.initials: M
authors.lastname: Grimm
authors.forename: Gudrun
authors.initials: G
authors.lastname: Feuchtner
mesh_terms: D000369:Aged, 80 and over; D000792:Angiography; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011446:Prospective Studies; D011474:Prosthesis Design; D015203:Reproducibility of Results; D012720:Severity of Illness Index