title: CT-angiography-based evaluation of the aortic annulus for prosthesis sizing in transcatheter aortic valve implantation (TAVI)-predictive value and optimal thresholds for major anatomic parameters.
abstract: OBJECTIVE
  To evaluate the predictive value of CT-derived measurements of the aortic annulus for prosthesis sizing in transcatheter aortic valve implantation (TAVI) and to calculate optimal cutoff values for the selection of various prosthesis sizes.
  
  
  METHODS
  The local IRB waived approval for this single-center retrospective analysis. Of 441 consecutive TAVI-patients, 90 were excluded (death within 30 days: 13; more than mild aortic regurgitation: 10; other reasons: 67). In the remaining 351 patients, the CoreValve (Medtronic) and the Edwards Sapien XT valve (Edwards Lifesciences) were implanted in 235 and 116 patients. Optimal prosthesis size was determined during TAVI by inflation of a balloon catheter at the aortic annulus. All patients had undergone CT-angiography of the heart or body trunk prior to TAVI. Using these datasets, the diameter of the long and short axis as well as the circumference and the area of the aortic annulus were measured. Multi-Class Receiver-Operator-Curve analyses were used to determine the predictive value of all variables and to define optimal cutoff-values.
  
  
  RESULTS
  Differences between patients who underwent implantation of the small, medium or large prosthesis were significant for all except the large vs. medium CoreValve (all p's<0.05). Furthermore, mean diameter, annulus area and circumference had equally high predictive value for prosthesis size for both manufacturers (multi-class AUC's: 0.80, 0.88, 0.91, 0.88, 0.88, 0.89). Using the calculated optimal cutoff-values, prosthesis size is predicted correctly in 85% of cases.
  
  
  CONCLUSIONS
  CT-based aortic root measurements permit excellent prediction of the prosthesis size considered optimal during TAVI.
authors.affiliation: Institute for Clinical Radiology, Hospital of the Ludwig Maximilian University of Munich, Munich, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Schwarz
authors.affiliation: Medical Clinic I - Cardiology, Hospital of the Ludwig Maximilian University of Munich, Munich, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Lange
authors.affiliation: Institute for Clinical Radiology, Hospital of the Ludwig Maximilian University of Munich, Munich, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Zinsser
authors.affiliation: Medical Clinic I - Cardiology, Hospital of the Ludwig Maximilian University of Munich, Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Greif
authors.affiliation: HELIOS Klinikum Siegburg, HELIOS Kliniken GmbH, Siegburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Boekstegers
authors.affiliation: Department of Cardiac Surgery, Hospital of the Ludwig Maximilian University of Munich, Munich, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmitz
authors.affiliation: Institute for Clinical Radiology, Hospital of the Ludwig Maximilian University of Munich, Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.affiliation: Medical Clinic I - Cardiology, Hospital of the Ludwig Maximilian University of Munich, Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Kupatt
authors.affiliation: Institute for Clinical Radiology, Hospital of the Ludwig Maximilian University of Munich, Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
authors.forename: Hans C
authors.initials: HC
authors.lastname: Becker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000473:pathology*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D001027:Aortography; D019540:Area Under Curve; D058385:Cardiac Valve Annuloplasty; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012016:Reference Values; D014057:Tomography, X-Ray Computed; D065467:Transcatheter Aortic Valve Replacement
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