title: Imaging for approach selection of TAVI: assessment of the aorto-iliac tract diameter by computed tomography-angiography versus projection angiography.
abstract: The choice of preferred access route for transcatheter aortic valve implantation (TAVI) is mainly guided by the minimal aorto-femoral tract diameter. Currently, projection angiography (XA) and CT-angiography (CTA) are used interchangeably to assess this diameter in the TAVI work-up. We aimed to assess the agreement of XA and CTA diameter measurements in TAVI candidates. Diameters of 700 aorta-iliac segments of 102 TAVI candidates were analyzed on both XA and CTA. The diameters on XA were measured manually, for the CTA-based analysis semi-automated segmentation software was used. Paired sample T test was used to evaluate differences in diameter measurements between the modalities. Disagreement on the suitability for a transfemoral (TF)-TAVI approach was identified. The interobserver agreement for both measurements was assessed by calculating the intraclass correlation coefficient (ICC). The average diameters were 10.1 ± 1.8 mm and 8.4 ± 1.7 for XA and CTA respectively. The mean paired difference was 1.73 mm (p < 0.001). For 18 patients (17.6 %) diameters measured on CTA images, were bilaterally less than 6 mm, whilst XA indicated a minimum diameter exceeding 6 mm. For both modalities, the interobserver agreement was excellent (ICC 0.95). Diameters measured semi-automatically on CTA were statistically significantly smaller compared to XA. This should be acknowledged in the work-up for selecting the most appropriate approach for TAVI. In our population 17.6 % of patients would have been denied a transfemoral TAVI based on CTA measurements, whilst XA suggested diameters sufficient for a TF approach.
authors: Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, e.m.wiegerinck@amc.uva.nl.
authors: E M A
authors: EM
authors: Wiegerinck
authors: H A
authors: HA
authors: Marquering
authors: N Y
authors: NY
authors: Oldenburger
authors: M A
authors: MA
authors: Elattar
authors: R N
authors: RN
authors: Planken
authors: B A J M
authors: BA
authors: De Mol
authors: J J
authors: JJ
authors: Piek
authors: J
authors: J
authors: Baan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D001027:Aortography / Q000379:methods*; D001331:Automation; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging*; D008297:Male; D015588:Observer Variation; D018579:Patient Selection; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012984:Software; D014057:Tomography, X-Ray Computed