title: Multidetector CT predictors of prosthesis-patient mismatch in transcatheter aortic valve replacement.
abstract: BACKGROUND
  Prosthesis-patient mismatch (PPM) is a predictor of mortality after aortic valve replacement (AVR).
  
  
  OBJECTIVE
  We examined whether accurate 3-dimensional annular sizing with multidetector CT (MDCT) is predictive of PPM after transcatheter AVR (TAVR).
  
  
  METHODS
  One hundred twenty-eight patients underwent MDCT then TAVR. Moderate PPM was defined as an indexed effective orifice area ≤0.85 cm²/m² and severe ≤0.65 cm²/m². MDCT annular measurements (area, short and long axis) were compared with the size of the selected transcatheter heart valve (THV) to obtain (1) the difference between prosthesis size and CT-measured mean annular diameter and (2) the percentage of undersizing or oversizing (calculated as 100 × [MDCT annular area--THV nominal area]/THV nominal area). In addition, the MDCT annular area was indexed to body surface area. These measures were evaluated as potential PPM predictors.
  
  
  RESULTS
  We found that 42.2% of patients had moderate PPM and 9.4% had severe PPM. Procedural characteristics and in-hospital outcomes were similar between patients with or without PPM. THV undersizing of the mean aortic annulus diameter was not predictive of PPM (odds ratio [OR], 0.84; 95% CI, 0.65-1.07; P = .16; area under the receiver-operating characteristic curve [AUC], 0.58). THV undersizing of annular area was not predictive of PPM (OR, 0.96; 95% CI, 0.80-1.16; P = .69; AUC, 0.52). Indexed MDCT annular area was, however, predictive of PPM (OR, 0.24; 95% CI, 0.10-0.59; P < .001; AUC, 0.66).
  
  
  CONCLUSIONS
  PPM is frequent after TAVR. Appropriate annular oversizing does not reduce the rate or severity of PPM. Patient annulus size mismatch, identified by indexed MDCT annular area, is a significant predictor of PPM.
authors.affiliation: Divisions of Cardiology and Cardiac Imaging, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
authors.forename: Melanie
authors.initials: M
authors.lastname: Freeman
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Willson
authors.forename: Miriam
authors.initials: M
authors.lastname: Wheeler
authors.forename: Philipp
authors.initials: P
authors.lastname: Blanke
authors.forename: Robert R
authors.initials: RR
authors.lastname: Moss
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Thompson
authors.forename: Brad
authors.initials: B
authors.lastname: Munt
authors.forename: Bjarne L
authors.initials: BL
authors.lastname: Norgaard
authors.forename: Tae-Hyun
authors.initials: TH
authors.lastname: Yang
authors.forename: James K
authors.initials: JK
authors.lastname: Min
authors.forename: Steen
authors.initials: S
authors.lastname: Poulsen
authors.forename: Nicolaj C
authors.initials: NC
authors.lastname: Hansson
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Binder
authors.forename: Stefan
authors.initials: S
authors.lastname: Toggweiler
authors.forename: Cameron
authors.initials: C
authors.lastname: Hague
authors.forename: David A
authors.initials: DA
authors.lastname: Wood
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D019540:Area Under Curve; D001955:British Columbia; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D016009:Chi-Square Distribution; D003718:Denmark; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional; D016015:Logistic Models; D008297:Male; D061330:Multidetector Computed Tomography; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012372:ROC Curve; D011857:Radiographic Image Interpretation, Computer-Assisted; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Aortic stenosis; Computed tomography; Prosthesis–patient mismatch; Prosthetic heart valve; Transcatheter aortic valve implantation; Transcatheter aortic valve replacement