Author + information
- Yash Jobanputra,
- Brandon Jones,
- Kimi Sato,
- Kinjal Banerjee,
- Krishna Kandregula,
- Amar Krishnaswamy,
- Stephanie Mick,
- Jose Navia and
- Samir Kapadia
Background: Computed tomography angiography (CTA) is used to predict the size and orientation of transcatheter aortic valve replacement (TAVR) devices in the annulus. We previously showed that the annular plane does not predict the orientation of the valve after deployment. We hypothesized that a novel plane parallel to the sinotubular junction (STJ) would better predict the angle of implantation.
Methods: Patients undergoing TAVR and pre-procedural CTA were evaluated. Each had left anterior oblique (LAO) cranial and right anterior oblique (RAO) caudal fluoroscopic imaging during TAVR. We determined the predicted angle of orientation at the same LAO/RAO angulations based on pre-TAVR CTA for each patient in the annular and the novel plane and measured differences in the corresponding cranial and caudal angulations.
Results: We retrospectively evaluated 111 consecutive patients, the mean LAO cranial projection by fluoroscopy was 33±100 by 9±40 vs 26±100 (annular) vs. 21±100(STJ)cranial as predicted by CTA at the same LAO angulation (p<0.01). The mean RAO caudal projection by fluoroscopy was 25±90 by 31±70 vs 24±110 (annular) vs. 19±90(STJ) caudal as predicted by CTA at the same RAO angulation (p<0.01).
Conclusions: The valves in our study took an orientation more horizontally and anteriorly tilted (towards the left coronary and right coronary cusps) than would have been predicted by CTA. Predicting valve orientation may be important in individuals with low coronary ostia or sino-tubular effacement.
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: 1114-158
- 2017 American College of Cardiology Foundation