title: Impact of optimising fluoroscopic implant angles on paravalvular regurgitation in transcatheter aortic valve replacements - utility of three-dimensional rotational angiography.
abstract: OBJECTIVE
  The clinical value of optimising implant angles during transcatheter aortic valve replacements (TAVR) remains undefined. The Aortic Valve Guide (AVG) is a proprietary software that provides structured analysis of three-dimensional images from rotational angiography (DynaCT). This study compares AVG with preprocedural multislice computed tomography (MSCT) and DynaCT in optimal implant angle prediction for TAVR, and evaluates if an optimised implant angle is associated with reduced paravalvular regurgitation (PVR).
  
  
  RESULTS
  One hundred and six consecutive patients were included, comprising three groups. Group 1 (n=19) underwent no preprocedural MSCT or DynaCT (or AVG); Group 2 (n=44) underwent periprocedural DynaCT, without AVG; Group 3 (n=43) had DynaCT with AVG. Implant angles yielded were graded as excellent, satisfactory or poor. Group 3 were more likely than Groups 2 and 1 to have excellent implant angles (83.7% vs. 52.3% vs. 42.1%, respectively, p=0.001). In 100 patients who had 30-day transthoracic echocardiogram follow-up, an excellent implant angle was significantly more likely to be associated with no PVR than a non-excellent angle (41.3% vs. 21.6%, respectively, p=0.045), independent of operator experience and THV used.
  
  
  CONCLUSIONS
  Optimising implant angles may be important in reducing PVR. This is significantly more likely to be achieved with AVG rotational angiography.
authors.affiliation: Cardiology Program, The Prince Charles Hospital, Brisbane, Australia. karlkpoon@gmail.com
authors.forename: Karl K
authors.initials: KK
authors.lastname: Poon
authors.forename: James
authors.initials: J
authors.lastname: Crowhurst
authors.forename: Christopher
authors.initials: C
authors.lastname: James
authors.forename: Douglas
authors.initials: D
authors.lastname: Campbell
authors.forename: Damian
authors.initials: D
authors.lastname: Roper
authors.forename: Jonathan
authors.initials: J
authors.lastname: Chan
authors.forename: Alexander
authors.initials: A
authors.lastname: Incani
authors.forename: Andrew
authors.initials: A
authors.lastname: Clarke
authors.forename: Peter
authors.initials: P
authors.lastname: Tesar
authors.forename: Constantine
authors.initials: C
authors.lastname: Aroney
authors.forename: Owen Christopher
authors.initials: OC
authors.lastname: Raffel
authors.forename: Darren L
authors.initials: DL
authors.lastname: Walters
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D006328:Cardiac Catheterization; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male