Author + information
- Received March 7, 2013
- Revision received April 13, 2013
- Accepted April 23, 2013
- Published online July 30, 2013.
- Ronald K. Binder, MD∗,
- John G. Webb, MD∗,
- Alexander B. Willson, MBBS∗,
- Marina Urena, MD†,
- Nicolaj C. Hansson, MD‡,
- Bjarne L. Norgaard, MD, PhD‡,
- Philippe Pibarot, MD†,
- Marco Barbanti, MD∗,
- Eric Larose, MD†,
- Melanie Freeman, MBBS∗,
- Eric Dumont, MD†,
- Chris Thompson, MD∗,
- Miriam Wheeler, MBChB∗,
- Robert R. Moss, MD∗,
- Tae-hyun Yang, MD∗,
- Sergio Pasian, MD†,
- Cameron J. Hague, MD∗,
- Giang Nguyen, MD∗,
- Rekha Raju, MD∗,
- Stefan Toggweiler, MD∗,
- James K. Min, MD§,
- David A. Wood, MD⋮,
- Josep Rodés-Cabau, MD† and
- Jonathon Leipsic, MD∗∗ ()
- ∗St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- †Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
- ‡Aarhus University Hospital Skejby, Aarhus, Denmark
- §Cedars-Sinai Heart Institute, Los Angeles, California
- ⋮Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- ↵∗Reprint requests and correspondence:
Dr. Jonathon Leipsic, St. Paul's Hospital, 1081 Burrard Street, V6Z 1Y6 Vancouver, British Columbia, Canada.
Objectives This study prospectively investigated the impact of integration of a multidetector computed tomography (MDCT) annular area sizing algorithm on transcatheter aortic valve replacement (TAVR) outcomes.
Background Appreciation of the 3-dimensional, noncircular geometry of the aortic annulus is important for transcatheter heart valve (THV) sizing.
Methods Patients being evaluated for TAVR in 4 centers underwent pre-procedural MDCT. Recommendations for balloon-expandable THV size selection were based on an MDCT sizing algorithm with an optimal goal of modest annulus area oversizing (5% to 10%). Consecutive patients who underwent TAVR with the algorithm (MDCT group) were compared with consecutive patients without the algorithm (control group). The primary endpoint was the incidence of more than mild paravalvular regurgitation (PAR), and the secondary endpoint was the composite of in-hospital death, aortic annulus rupture, and severe PAR.
Results Of 266 patients, 133 consecutive patients underwent TAVR (SAPIEN XT THV) in the MDCT group and 133 consecutive patients were in the control group. More than mild PAR was present in 5.3% (7 of 133) of the MDCT group and in 12.8% (17 of 133) in the control group (p = 0.032). The combined secondary endpoint occurred in 3.8% (5 of 133) of the MDCT group and in 11.3% (15 of 133) of the control group (p = 0.02), driven by the difference of severe PAR.
Conclusions The implementation of an MDCT annulus area sizing algorithm for TAVR reduces PAR. Three-dimensional aortic annular assessment and annular area sizing should be considered for TAVR.
- annulus area
- multidetector computed tomography
- transcatheter aortic valve replacement
- transcatheter heart valve sizing
Edwards Lifesciences funded the image transfer but had no involvement in data collection, data analysis, or manuscript writing. Drs. Binder, Webb, Norgaard, Dumont, Wood, Rodés-Cabau, and Leipsic are consultants to Edwards Lifesciences. Drs. Binder and Toggweiler received unrestricted research grants from the Swiss National Foundation. Drs. Hansson and Pibarot received research grants from Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 7, 2013.
- Revision received April 13, 2013.
- Accepted April 23, 2013.
- American College of Cardiology Foundation