title: Three-dimensional multidetector computed tomography versus conventional 2-dimensional transesophageal echocardiography for annular sizing in transcatheter aortic valve replacement: Influence on postprocedural paravalvular aortic regurgitation.
abstract: OBJECTIVE
  In transcatheter aortic valve replacement (TAVR), the influence of aortic annular assessment with either multidetector computed tomography (MDCT) or conventional transesophageal echocardiography (TEE) on the incidence of postprocedural paravalvular aortic regurgitation (PAR) was evaluated.
  
  
  BACKGROUND
  PAR remains a major limitation in TAVR. Appropriate selection of transcatheter heart valve (THV) size is crucial to prevent PAR.
  
  
  METHODS
  Outcomes following TAVR with a balloon-expandable THV were compared in two retrospective cohorts identified according to whether THV size selection was based on TEE (study group 1, n = 80) or MDCT (study group 2, n = 58).
  
  
  RESULTS
  The two study groups were comparable with regard to baseline clinical, risk score, and echocardiographic characteristics. The incidence of moderate/severe PAR was lower in study group 2 than in group 1, 8.6% versus 28.8% (P < 0.01). The difference between the THV nominal diameter and MDCT annular diameter was predictive of moderate/severe PAR (AUC 0.84; 95% CI: 0.72-0.92). Neither age, gender, body mass index, annular eccentricity index, aortic valve calcification nor the difference between the THV diameter and the TEE annular diameter predicted postprocedural PAR. Increased THV oversizing relative to the MDCT mean annular diameter was associated with reduced severity of PAR. No difference in perprocedural complications between two study groups was observed.
  
  
  CONCLUSIONS
  MDCT-based annular sizing in TAVR significantly reduces postprocedural PAR, and THV oversizing appears pivotal in this aspect. Further delineation of the optimal degree of THV oversizing is needed.
authors.affiliation: Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.
authors.forename: Nicolaj C
authors.initials: NC
authors.lastname: Hansson
authors.forename: Leif
authors.initials: L
authors.lastname: Thuesen
authors.forename: Vibeke E
authors.initials: VE
authors.lastname: Hjortdal
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.forename: Henning R
authors.initials: HR
authors.lastname: Andersen
authors.forename: Steen H
authors.initials: SH
authors.lastname: Poulsen
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.forename: Evald H
authors.initials: EH
authors.lastname: Christiansen
authors.forename: Lars E
authors.initials: LE
authors.lastname: Rasmussen
authors.forename: Lars R
authors.initials: LR
authors.lastname: Krusell
authors.forename: Kim
authors.initials: K
authors.lastname: Terp
authors.forename: Kaj E
authors.initials: KE
authors.lastname: Klaaborg
authors.forename: Mariann
authors.initials: M
authors.lastname: Tang
authors.forename: Jens F
authors.initials: JF
authors.lastname: Lassen
authors.forename: Hans E
authors.initials: HE
authors.lastname: Bøtker
authors.forename: Bjarne L
authors.initials: BL
authors.lastname: Nørgaard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging*; D001022:Aortic Valve Insufficiency / Q000453:epidemiology / Q000517:prevention & control*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D003718:Denmark / Q000453:epidemiology; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D021621:Imaging, Three-Dimensional; D015994:Incidence; D008297:Male; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Transcatheter aortic valve replacement; aortic annulus; computed tomography; echocardiography; paravalvular regurgitation; valve sizing