Author + information
- Received October 12, 2011
- Revision received December 6, 2011
- Accepted December 20, 2011
- Published online April 3, 2012.
- Alexander B. Willson, MBBS, MPH⁎,
- John G. Webb, MD⁎,
- Troy M. LaBounty, MD†,
- Stephan Achenbach, MD‡,
- Robert Moss, MBBS⁎,
- Miriam Wheeler, MBBS⁎,
- Christopher Thompson, MD⁎,
- James K. Min, MD†,
- Ronen Gurvitch, MBBS⁎,
- Bjarne L. Norgaard, MD§,
- Cameron J. Hague, MD⁎,
- Stefan Toggweiler, MD⁎,
- Ronald Binder, MD⁎,
- Melanie Freeman, MBBS⁎,
- Rohan Poulter, MBBS⁎,
- Steen Poulsen, MD§,
- David A. Wood, MD⁎ and
- Jonathon Leipsic, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Jonathon Leipsic, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
Objectives This study sought to analyze multidetector computed tomography (MDCT) 3-dimensional aortic annular dimensions for the prediction of paravalvular aortic regurgitation (PAR) following transcatheter aortic valve replacement (TAVR).
Background Moderate or severe PAR after TAVR is associated with increased morbidity and mortality.
Methods A total of 109 consecutive patients underwent MDCT pre-TAVR with a balloon expandable aortic valve. Differences between transcatheter heart valve (THV) size and MDCT measures of annular size (mean diameter, area, and circumference) were analyzed concerning prediction of PAR. Patients with THV malposition (n = 7) were excluded. In 50 patients, MDCT was repeated after TAVR to assess THV eccentricity (1 – short diameter/long diameter) and expansion (MDCT measured THV area/nominal THV area).
Results Moderate or severe PAR (13 of 102) was associated with THV undersizing (THV diameter – mean diameter = –0.7 ± 1.4 mm vs. 0.9 ± 1.8 mm for trivial to mild PAR, p < 0.01). The difference between THV size and MDCT annular size was predictive of PAR (mean diameter: area under the curve [AUC]: 0.81, 95% confidence interval [CI]: 0.68 to 0.88; area: AUC: 0.80, 95% CI: 0.65 to 0.90; circumference: AUC: 0.76, 95% CI: 0.59 to 0.91). Annular eccentricity was not associated with PAR (AUC: 0.58, 95% CI: 0.46 to 0.75). We found that 35.3% (36 of 102) and 45.1% (46 of 102) of THVs were undersized relative to the MDCT mean diameter and area, respectively. THV oversizing relative to the annular area was not associated with THV eccentricity or underexpansion (oversized vs. undersized THVs; expansion: 102.7 ± 5.3% vs. 106.1 ± 5.6%, p = 0.03; eccentricity: median: 1.7% [interquartile range: 1.4% to 3.0%] vs. 1.7% [interquartile range: 1.1% to 2.7%], p = 0.28).
Conclusions MDCT-derived 3-dimensional aortic annular measurements are predictive of moderate or severe PAR following TAVR. Oversizing of THVs may reduce the risk of moderate or severe PAR.
- aortic annulus
- multidetector computed tomography
- paravalvular aortic regurgitation
- transcatheter aortic valve implantation
- transcatheter aortic valve replacement
Dr. Webb is a consultant for Siemens Medical and Edwards Lifesciences. Dr. Achenbach has received grant support from Siemens and Bayer Schering Pharma; and speaker honoraria from Siemens. Drs. Moss and Leipsic are consultants for Edwards Lifesciences. Dr. Min is on the Speaker's Bureau and medical advisory board of GE Healthcare; is a consultant for Edwards Lifesciences; and has equity interest in TC3. Drs. Toggweiler and Binder are supported by unrestricted grants from the Swiss National Foundation. Dr. Wood has relationships with Edwards Lifesciences and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 12, 2011.
- Revision received December 6, 2011.
- Accepted December 20, 2011.
- American College of Cardiology Foundation