title: Assessment of a novel software tool in the selection of aortic valve prosthesis size for transcatheter aortic valve replacement.
abstract: BACKGROUND
  Transcatheter aortic valve replacement (TAVR) can be complicated by significant paravalvular leak (PVL). Optimal selection of TAVR prosthesis size can minimize the risk of clinically significant PVL. The aim of this study was to assess the utility of a proprietary software package, HeartNavigator (Philips), in selecting TAVR prosthesis to minimize PVL.
  
  
  METHODS
  All consecutive TAVR patients were considered for inclusion. HeartNavigator assessment was compared to three conventional (average, area-based, and circumference- based) computed tomography (CT) scan measurements of annulus diameter. The primary endpoint was clinically important (≥2+) aortic insufficiency (AI).
  
  
  RESULTS
  Fifty-six patients were suitable for analysis. The incidence of clinically important AI was 25%. The overall predictive value was identical for HeartNavigator (80.4%) and the three conventional CT parameters. Each method correctly identified a majority of patients destined for AI. Although HeartNavigator accurately identified a numerically greater portion of patients with AI (64.3%), this was not significantly different from the conventional CT parameters.
  
  
  CONCLUSIONS
  As compared to conventional CT-based measurements, HeartNavigator offers an accurate method for selecting TAVR prostheses, comparable to conventional CT measurements.
authors.affiliation: Cardiology Division (Mail Stop 111D), Bay Pines VA Medical Center, PO Box 5005, 10000 Bay Pines Blvd, Bay Pines, FL 33744 USA. Paul.vaitkus@va.gov.
authors.forename: Paul T
authors.initials: PT
authors.lastname: Vaitkus
authors.forename: Dee Dee
authors.initials: DD
authors.lastname: Wang
authors.forename: Adam
authors.initials: A
authors.lastname: Greenbaum
authors.forename: Mayra
authors.initials: M
authors.lastname: Guerrero
authors.forename: William
authors.initials: W
authors.lastname: O'Neill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011474:Prosthesis Design; D017755:Prosthesis Fitting / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012984:Software; D014057:Tomography, X-Ray Computed; D065467:Transcatheter Aortic Valve Replacement / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome