title: Impact of CT-guided valve sizing on post-procedural aortic regurgitation in transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Transoesophageal echocardiography (TEE) is considered the gold standard method for annulus measurement in transcatheter aortic valve implantation (TAVI). However, computed tomography (CT) has potential advantages compared to TEE. We sought to assess the impact of CT-guided valve sizing on post-procedural aortic regurgitation (AR).
  
  
  RESULTS
  We compared procedural characteristics and clinical outcomes in patients undergoing either TEE-guided or CT-guided TAVI. Among 350 consecutive TAVI recipients, the mean age was 83.2 ± 6.4 years and the logistic EuroSCORE was 22.4 ± 11.2%. The mean Diam-TEE was similar in both groups (22.3 ± 1.9 mm vs. .0 ± 1.8 mm, p=0.092). The mean annulus diameter by CT (mDiam-CT) was larger than mean Diam-TEE (23.6 ± 2.0 mm vs. 22.3 ± 1.9 mm, p<0.001), and resulted in larger valve implant sizes compared to the TEE-guided group (25.8 ± 2.1 mm vs. 25.0 ± 1.9 mm, p<0.001). The incidence of post-procedural AR ≥ grade 2 was significantly reduced in the CT-guided group (15.4% vs. 24.0%, p=0.044), with a similar risk of annulus rupture (0.6% vs. 1.7%, p=0.31). The only predictor of post-procedural AR ≥ 2 was the "valve/mDiam-CT ratio" (HR 0.36 by increase of 0.1, 95% CI: 0.17-0.77, p=0.008) by multivariate analysis.
  
  
  CONCLUSIONS
  CT-guided valve sizing in TAVI significantly reduces the incidence of post-procedural AR compared to TEE sizing. This strategy may have the potential to improve clinical outcomes.
authors.affiliation: Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashida
authors.forename: Erik
authors.initials: E
authors.lastname: Bouvier
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefèvre
authors.forename: Thomas
authors.initials: T
authors.lastname: Hovasse
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.forename: Bernard
authors.initials: B
authors.lastname: Chevalier
authors.forename: Mauro
authors.initials: M
authors.lastname: Romano
authors.forename: Philippe
authors.initials: P
authors.lastname: Garot
authors.forename: Darren
authors.initials: D
authors.lastname: Mylotte
authors.forename: Arnaud
authors.initials: A
authors.lastname: Farge
authors.forename: Patrick
authors.initials: P
authors.lastname: Donzeau-Gouge
authors.forename: Bertrand
authors.initials: B
authors.lastname: Cormier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000453:epidemiology*; D006328:Cardiac Catheterization; D017548:Echocardiography, Transesophageal; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed / Q000379:methods*