title: The impact of integration of a multidetector computed tomography annulus area sizing algorithm on outcomes of transcatheter aortic valve replacement: a prospective, multicenter, controlled trial.
abstract: OBJECTIVE
  This study prospectively investigated the impact of integration of a multidetector computed tomography (MDCT) annular area sizing algorithm on transcatheter aortic valve replacement (TAVR) outcomes.
  
  
  BACKGROUND
  Appreciation of the 3-dimensional, noncircular geometry of the aortic annulus is important for transcatheter heart valve (THV) sizing.
  
  
  METHODS
  Patients being evaluated for TAVR in 4 centers underwent pre-procedural MDCT. Recommendations for balloon-expandable THV size selection were based on an MDCT sizing algorithm with an optimal goal of modest annulus area oversizing (5% to 10%). Consecutive patients who underwent TAVR with the algorithm (MDCT group) were compared with consecutive patients without the algorithm (control group). The primary endpoint was the incidence of more than mild paravalvular regurgitation (PAR), and the secondary endpoint was the composite of in-hospital death, aortic annulus rupture, and severe PAR.
  
  
  RESULTS
  Of 266 patients, 133 consecutive patients underwent TAVR (SAPIEN XT THV) in the MDCT group and 133 consecutive patients were in the control group. More than mild PAR was present in 5.3% (7 of 133) of the MDCT group and in 12.8% (17 of 133) in the control group (p = 0.032). The combined secondary endpoint occurred in 3.8% (5 of 133) of the MDCT group and in 11.3% (15 of 133) of the control group (p = 0.02), driven by the difference of severe PAR.
  
  
  CONCLUSIONS
  The implementation of an MDCT annulus area sizing algorithm for TAVR reduces PAR. Three-dimensional aortic annular assessment and annular area sizing should be considered for TAVR.
authors.affiliation: St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Binder
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Willson
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.forename: Nicolaj C
authors.initials: NC
authors.lastname: Hansson
authors.forename: Bjarne L
authors.initials: BL
authors.lastname: Norgaard
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.forename: Eric
authors.initials: E
authors.lastname: Larose
authors.forename: Melanie
authors.initials: M
authors.lastname: Freeman
authors.forename: Eric
authors.initials: E
authors.lastname: Dumont
authors.forename: Chris
authors.initials: C
authors.lastname: Thompson
authors.forename: Miriam
authors.initials: M
authors.lastname: Wheeler
authors.forename: Robert R
authors.initials: RR
authors.lastname: Moss
authors.forename: Tae-hyun
authors.initials: TH
authors.lastname: Yang
authors.forename: Sergio
authors.initials: S
authors.lastname: Pasian
authors.forename: Cameron J
authors.initials: CJ
authors.lastname: Hague
authors.forename: Giang
authors.initials: G
authors.lastname: Nguyen
authors.forename: Rekha
authors.initials: R
authors.lastname: Raju
authors.forename: Stefan
authors.initials: S
authors.lastname: Toggweiler
authors.forename: James K
authors.initials: JK
authors.lastname: Min
authors.forename: David A
authors.initials: DA
authors.lastname: Wood
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
mesh_terms: D000369:Aged, 80 and over; D000465:Algorithms; D001019:Aortic Rupture / Q000453:epidemiology; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000453:epidemiology; D001024:Aortic Valve Stenosis / Q000601:surgery; D021721:Balloon Occlusion; D006328:Cardiac Catheterization; D003287:Contrast Media; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D061330:Multidetector Computed Tomography; D011446:Prospective Studies; D017755:Prosthesis Fitting / Q000379:methods*; D012720:Severity of Illness Index; D014463:Ultrasonography
chemical_list: D003287:Contrast Media
keywords: MDCT; PAR; TAVR; TEE; THV; TTE; annulus area; multidetector computed tomography; paravalvular regurgitation; transcatheter aortic valve replacement; transcatheter heart valve; transcatheter heart valve sizing; transesophageal echocardiography; transthoracic echocardiography