title: Safety considerations during transapical aortic valve implantation.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) is a new method for the treatment of very high-risk patients with aortic valve stenosis. The radiation dose to which the patient and each member of the heart team are exposed during this new fluoroscopically guided intervention is unknown.
  
  
  METHODS
  Between April 2008 and August 2013, 1177 consecutive patients underwent transapical TAVI (TA-TAVI). In 22 consecutive patients undergoing TA-TAVI, the radiation doses to the cardiothoracic surgeon, cardiologist, anaesthesiologist (performing echocardiography examination), surgical assistant and nurse were measured. The radiation dose measurements were performed during TAVI using thermoluminescence and film dosimeters positioned on seven parts of the body: (i) chest above the lead apron, (ii) pelvic area below the apron, (iii) chest below the apron, (iv) thyroid gland above the apron, (v) near eyes, (vi) hands (using rings) and (vii) the feet. The results were compared with the values given in the international literature on recommended radiation dose limits for workers.
  
  
  RESULTS
  The mean radiation time was 6.1 min and the mean dose-area product for the patients was 8.661 µGy · m(2). Analysis of the dosimeters and the calculation of the effective dose showed a per intervention dose of 0.03 mSv for the surgeon, 0.05 mSv for the assistant, 0.02 mSv for the cardiologist and the anaesthesiologist and 0.001 mSv for the nurse. The maximum ionizing radiation per intervention was 0.5 mSv at the right hand of the surgeon (holding the introducer sheet) and 0.7 mSv at the left hand of the surgical assistant. Additionally, the analysis of the body dose shows a maximum dose to the lower leg of the surgeon (0.3 mSv) and the genital area of the assistant (0.06 mSv).
  
  
  CONCLUSIONS
  During a TA-TAVI procedure, the patients receive a higher X-ray dose than during coronary angiography with intervention. After 100 TAVI procedures, the members of the heart team sustain a comparable dose of ionizing radiation to the annual dose received by a busy interventional cardiologist. Therefore, maximal safety and optimal X-ray protection for patients and the members of the team are crucial and should be redefined.
authors: Deutsches Herzzentrum Berlin, Berlin, Germany.
authors: Thorsten
authors: T
authors: Drews
authors: Miralem
authors: M
authors: Pasic
authors: Ralf
authors: R
authors: Juran
authors: Axel
authors: A
authors: Unbehaun
authors: Stephan
authors: S
authors: Dreysse
authors: Marian
authors: M
authors: Kukucka
authors: Alexander
authors: A
authors: Mladenow
authors: Roland
authors: R
authors: Hetzer
authors: Semih
authors: S
authors: Buz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects; D005260:Female; D005373:Film Dosimetry; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D016273:Occupational Exposure; D016272:Occupational Health; D010348:Patient Care Team; D061214:Patient Safety; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D011835:Radiation Protection; D015641:Radiography, Interventional / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D013819:Thermoluminescent Dosimetry; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aortic valve; Radiation; Safety; Transapical aortic valve implantation; Transcatheter aortic valve implantation; Valves; X-ray