Balloon Versus Computed Tomography Sizing of the Aortic Annulus for Transcatheter Aortic Valve Replacement and the Impact of Left Ventricular Outflow Tract Calcification and Morphology on Sizing.
OBJECTIVE
To evaluate the role of balloon annular sizing in transcatheter aortic valve replacement (TAVR).


BACKGROUND
Multidetector cardiac computed tomography (MDCT) is the gold standard for aortic annular sizing in TAVR. Balloon sizing is increasingly used in patients with borderline annular size and severe calcification. A comparison between these two techniques is needed.


METHODS
We retrospectively compared baseline characteristics and 30-day outcomes of patients undergoing balloon-expandable TAVR using annular MDCT or balloon sizing. Paravalvular leak (PVL) rates were compared adjusting for access site, valve generation, size, and valve calcification.


RESULTS
A total of 205 patients underwent TAVR with MDCT (n = 110) or balloon sizing (n = 95). Balloon-sized patients were older (83 years vs 81 years; P=.03), had more valve calcification (60.2% vs 30.9%; P<.001), and underwent more minimalist TAVR (61.1% vs 40%; P=.03). Although we found no difference between balloon and MDCT sizing in rates of acute renal failure (3.2% vs 0.9%; P=.34), annular rupture (1.1% vs 1.8%; P>.99), ≥ mild PVL by angiography (40% vs 35.5%; P=.57), or 30-day transthoracic echocardiography (40.7% vs 29.3%; P=.78), balloon-sized patients had a higher aortic regurgitation index (≥25) of 74.4% vs 54.1% (P=.01). Thirty-day rates of ≥ moderate PVL were 7.0% with balloon and 5.7% with MDCT sizing (P=.34). Balloon sizing recommended a different valve size in 34.0% of patients who underwent both methods (n = 50). A different recommendation occurred more often in patients with moderate/severe annular calcification (50.0% vs 33.3%; P=.01) and non-tubular left ventricular outflow tracts (LVOTs) (70.6% vs 30.3%; P=.01).


CONCLUSIONS
Balloon sizing can be a complement to MDCT for annular sizing in TAVR, especially in patients with moderate/severe annular calcification, borderline annular size, and non-tubular LVOT.
Jose F
JF
Condado
Stamatios
S
Lerakis
James
J
Stewart
Hanna
H
Jensen
Travis S
TS
Henry
Sung Min
SM
Ko
Arthur
A
Stillman
Mohammad H
MH
Rajaei
Kreton
K
Mavromatis
Chandan
C
Devireddy
Eric
E
Sarin
Brad
B
Leshnower
Robert
R
Guyton
Brian
B
Kaebnick
Vinod H
VH
Thourani
Peter C
PC
Block
Emory University Hospital, F606, 1364 Clifton Road, Atlanta, GA 30322 USA. vbabali@emory.edu.
Vasilis
V
Babaliaros
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery; D002114:Calcinosis / Q000000981:diagnostic imaging; D006328:Cardiac Catheterization / Q000379:methods*; D061827:Dimensional Measurement Accuracy; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D009929:Organ Size; D018579:Patient Selection; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D014481:United States; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000473:pathology