Aortic annulus area assessment by multidetector computed tomography for predicting paravalvular regurgitation in patients undergoing balloon-expandable transcatheter aortic valve implantation: a comparison with transthoracic and transesophageal echocardiography.
BACKGROUND
Transcatheter aortic valve implantation (TAVI) is a valid alternative to surgery in high-risk patients with severe aortic stenosis. Aortic annulus (AoA) sizing is crucial for TAVI success. The aim of the study was to compare AoA dimensions measured by multidetector computed tomography (MDCT) vs those obtained with transthoracic (TTE) and transesophageal echocardiography (TEE) for predicting paravalvular aortic regurgitation (PVR) after TAVI.


METHODS
Aortic annulus maximum diameter, minimum diameter, and area were assessed using MDCT and compared with TTE and TEE diameter and area for predicting PVR after TAVI in 151 patients (45 men, age 81.2 ± 6.4 years).


RESULTS
Aortic annulus maximum, minimum diameter, and area detected by MDCT were 25.04 ± 2.39 mm, 21.27 ± 2.10 mm, and 420.87 ± 76.10 mm(2), respectively. Aortic annulus diameter and area measured by TTE and TEE were 21.14 ± 1.94 mm and 353.82 ± 64.57 mm(2) and 22.04 ± 1.94 mm and 384.33 ± 67.30 mm(2), respectively. A good correlation was found between AoA diameters and area evaluated by MDCT vs TTE and TEE (0.61, 0.65, and 0.69 and 0.61, 0.65, and 0.70, respectively), with a mean difference of 3.90 ± 1.98 mm, 0.13 ± 1.67 mm, and 67.05 ± 55.87 mm(2) and 3.0 ± 2.0 mm, 0.77 ± 1.70 mm, and 36.54 ± 56.43 mm(2), respectively. Grade ≥2 PVR occurred in 46 patients and was related to male gender, higher body mass index, preprocedural aortic regurgitation, and lower mismatch between the nominal area of the implanted prosthesis and AoA area detected by MDCT.


CONCLUSIONS
Mismatch between prosthesis area and AoA area detected by MDCT is a better predictor of PVR as compared with echocardiography mismatch. Specific MDCT-based sizing recommendations should be developed.
Centro Cardiologico Monzino, IRCCS, Milan, Italy. gianluca.pontone@ccfm.it
Gianluca
G
Pontone
Daniele
D
Andreini
Antonio L
AL
Bartorelli
Erika
E
Bertella
Sarah
S
Cortinovis
Saima
S
Mushtaq
Andrea
A
Annoni
Alberto
A
Formenti
Andrea
A
Baggiano
Edoardo
E
Conte
Gloria
G
Tamborini
Manuela
M
Muratori
Paola
P
Gripari
Francesca
F
Bovis
Fabrizio
F
Veglia
Claudia
C
Foti
Francesco
F
Alamanni
Giovanni
G
Ballerini
Cesare
C
Fiorentini
Mauro
M
Pepi
D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000601:surgery*; D004452:Echocardiography / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods; D009929:Organ Size; D011183:Postoperative Complications / Q000000981:diagnostic imaging*