title: Impact of electrocardiogram-gated multi-slice computed tomography-based aortic annular measurement in the evaluation of paravalvular leakage following transcatheter aortic valve replacement: the efficacy of the OverSized AortiC Annular ratio (OSACA ratio) in TAVR.
abstract: BACKGROUND
  Even mild paravalvular leakage (PVL) after transcatheter aortic valve replacement (TAVR) is associated with increased late mortality. Electrocardiogram-gated multi-slice computed tomography (MSCT) enables detailed aortic annulus assessment. We describe the impact of MSCT for PVL following TAVR.
  
  
  METHODS
  Congruence between the prosthesis and annulus diameters affects PVL; therefore, we calculated the OverSized AortiC Annular ratio (OSACA ratio) and OSACA (transesophageal echocardiography, TEE) ratio as prosthesis diameter/annulus diameter on MSCT or TEE, respectively, and compared their relationship with PVL ≤ trace following TAVR.
  
  
  RESULTS
  Of 36 consecutive patients undergoing TAVR (Group A), the occurrence of PVL ≤ trace (33.3%) was significantly related to the OSACA ratio (p = 0.00020). In receiver-operating characteristics analysis, the cutoff value of 1.03 for the OSACA ratio had the highest sum of sensitivity (75.0%) and specificity (91.7%; AUC = 0.87) with significantly higher discriminatory performance for PVL as compared to the OSACA (TEE) ratio (AUC = 0.69, p = 0.028). In nine consecutive patients (Group B) undergoing TAVR based on guidelines formulated from our experience with Group A, PVL ≤ trace was significantly more frequent (88.9%) than that in Group A (p = 0.0060).
  
  
  CONCLUSIONS
  The OSACA ratio has a significantly higher discriminatory performance for PVL ≤ trace than the OSACA (TEE) ratio, and aortic annular measurement from MSCT is more accurate than that from TEE.
authors.affiliation: Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Maeda
authors.forename: Toru
authors.initials: T
authors.lastname: Kuratani
authors.forename: Kei
authors.initials: K
authors.lastname: Torikai
authors.forename: Kazuo
authors.initials: K
authors.lastname: Shimamura
authors.forename: Isamu
authors.initials: I
authors.lastname: Mizote
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ichibori
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Takeda
authors.forename: Takashi
authors.initials: T
authors.lastname: Daimon
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nakatani
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Nanto
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000473:pathology*; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D011183:Postoperative Complications; D011474:Prosthesis Design / Q000009:adverse effects* / Q000379:methods*; D011475:Prosthesis Failure / Q000209:etiology*; D017755:Prosthesis Fitting / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies