Author + information
- Sanjum S. Sethi,
- William Suh,
- Kathryn Cardoza,
- Murray Kwon,
- Richard Shemin,
- J. Paul FInn,
- Gabriel Vorobiof,
- Eric Yang and
- Olcay Aksoy
Background: Computed tomography angiography (CTA) is the standard for aortic annulus sizing prior to transcatheter aortic valve replacement (TAVR). However, patients with underlying chronic kidney disease (CKD) may not safely undergo a pre procedural CTA or magnetic resonance imaging (MRI) with gadolinium due to the risk of contrast induced nephropathy and nephrogenic systemic fibrosis, respectively. The contrast agent ferumoyxtol is safe in CKD. We investigated the impact of pre procedural annular sizing using MRI with ferumoxytol on procedural complications, paravalvular regurgitation, and mortality.
Methods: Consecutive patients (n = 220) undergoing TAVR with a balloon expandable stented valve from 2012 to 2016 were included. Data was collected as part of a registry and by reviewing the chart. Patients were divided into two groups based on pre procedural imaging type (CTA versus (vs) MRI with ferumoxytol). Annulus sizing was confirmed using 3 dimensional transesophageal echocardiogram. Pre-procedural clinical characteristics and outcomes including mortality and paravalvular regurgitation were evaluated between the groups.
Results: The mean age was 83 years and 49% were men. MRI with ferumoxytol was performed in 20 patients (9%), all of whom had a baseline creatinine 1.4 mg/dL or greater. The MRI group had significantly more men (75% vs 48%, p = 0.02) and a higher baseline creatinine (1.8 mg/dL vs 1.3 mg/dL, p = 0.02). The incidence of mild or greater paravalvular regurgitation was similar between groups occurring in 32% of patients in each arm. The post procedure aortic valve mean gradient (8.2 mmHg vs 9.8 mmHg) and aortic valve area (1.92 cm2 vs 2.07 cm2) were also not statistically different. Procedural characteristics and complications were similar between groups except significantly less contrast (133 ml vs 94 ml, p = 0.01) was used in the MRI group. There was no statistical difference in 30 day mortality.
Conclusions: MRI with ferumoxytol is a safe and effective strategy to measure annulus size prior to TAVR. The similar outcomes to CTA with respect to paravalvular regurgitation and procedural complications indicate that it may be a reasonable alternative to CTA in patients with underlying CKD.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Interventional Cardiology: TAVR 1
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1114-154
- 2017 American College of Cardiology Foundation