Author + information
- Received October 3, 2011
- Revision received November 10, 2011
- Accepted November 13, 2011
- Published online April 3, 2012.
- Hasan Jilaihawi, BSc (Hons), MBChB⁎,
- Mohammad Kashif, MD⁎,
- Gregory Fontana, MD†,
- Azusa Furugen, MD, PhD⁎,
- Takahiro Shiota, MD⁎,
- Gerald Friede, BS, MS⁎,
- Rakhee Makhija, MD⁎,
- Niraj Doctor, MBBS⁎,
- Martin B. Leon, MD‡ and
- Raj R. Makkar, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Raj R. Makkar, Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, California 90048
Objectives In an effort to define the gold standard for annular sizing for transcatheter aortic valve replacement (TAVR), we sought to critically analyze and compare the predictive value of multiple measures of the aortic annulus for post-TAVR paravalvular (PV) regurgitation and then assess the impact of a novel cross-sectional computed tomographic (CT) approach to annular sizing.
Background Recent studies have shown clear discrepancies between conventional 2-dimensional (2D) echocardiographic and CT measurements. In terms of aortic annular measurement for TAVR, such findings have lacked the outcome analysis required to inform clinical practice.
Methods The discriminatory value of multiple CT annular measures for post-TAVR PV aortic regurgitation was compared with 2D echocardiographic measures. TAVR outcomes with device selection according to aortic annular sizing using a traditional 2D transesophageal echocardiography–guided or a novel CT-guided approach were also studied.
Results In receiver-operating characteristic models, cross-sectional CT parameters had the highest discriminatory value for post-TAVR PV regurgitation: This was with the area under the curve for [maximal cross-sectional diameter minus prosthesis size] of 0.82 (95% confidence interval: 0.69 to 0.94; p < 0.001) and that for [circumference-derived cross-sectional diameter minus prosthesis size] of 0.81 (95% confidence interval: 0.7 to 0.94; p < 0.001). In contrast, traditional echocardiographic measures were nondiscriminatory in relation to post-TAVR PV aortic regurgitation. The prospective application of a CT-guided annular sizing approach resulted in less PV aortic regurgitation of grade worse than mild after TAVR (7.5% vs. 21.9%; p = 0.045).
Conclusions Our data lend strong support to 3-dimensional cross-sectional measures, using CT as the new gold standard for aortic annular evaluation for TAVR with the Edwards SAPIEN device.
- aortic annulus
- aortic stenosis
- computed tomography
- paravalvular aortic regurgitation
- transcatheter aortic valve implantation
- transcatheter aortic valve replacement
Dr. Jilaihawi is a consultant to Edwards Lifesciences, St. Jude Medical, and Venus Medtech. Dr. Fontana is a national principal investigator for, on the scientific advisory board of, has received research support for, and is a consultant for St. Jude Medical; is a consultant for and on the scientific advisory board of Sorin Medical; is on speaker's bureau of Medtronic; and has equity interest in and is a consultant for Entourage Medical. Dr. Shiota is on the speaker's bureau for Philips Medical Systems. Dr. Makkar is a principal site investigator for the US-PARTNER trial for Edwards-Lifesciences; has received consulting fees, grant support, and lecture fees from Abbott, Medtronic, and Lilly; has received consulting fees and grant support from Johnson & Johnson and Daiichi Sankyo; has received grant support from St. Jude Medical; and has received equity from Entourage Medical Technologies. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 3, 2011.
- Revision received November 10, 2011.
- Accepted November 13, 2011.
- American College of Cardiology Foundation