Author + information
- Hector Crespo1,
- Roberto J. Cubeddu1,
- Gianina Flocco1,
- Andres Carmona1,
- Mark Rothenberg2,
- Lawrence Lovitz3,
- George Daniels4,
- Eric Heller5,
- Lance Lester6 and
- Marcos Nores7
- 1Cleveland Clinic Florida, Weston, Florida, United States
- 2University of Miami School of Medicine/JFK Medical Center, Atlantis, Florida, United States
- 3University of Miami School of Medicine/JFK Medical Center, West Palm Beach, Florida, United States
- 4JFK, Atlantis, Florida, Florida, United States
- 5Seckler Heart Center, Boca Raton, Florida, United States
- 6JFK, Lake worth, Florida, United States
- 7JFK Medical Center, Wellington, Florida, United States
Annular derived measurements from gated multislice computed tomography (MSCT) remains the clinical sizing guide for valve selection in TAVR. However, the use of this measurement alone is sometimes insufficient for appropriate valve sizing, and at times vulnerable to motion artifact. The technique requires the use of contrast, and is therefore problematic in those with nephropathy or severe contrast allergy. In this subset of patients, the use of an additional sizing guide may be beneficial.
A multicenter retrospective analysis was conducted in 536 consecutive patients who underwent TAVR with Edwards SAPIEN 3 between 2015 and 2017. Only patients with high quality contrast gated MSCT for determination of annular size were included in the study (n=329). The actual valve size implanted was considered the gold standard. Interquartile ranges for SoV mean diameter were obtained, and ROC curves were constructed for the old and new parameters and analyzed with logistic regression.
ROC curves of the SoV mean diameter for each valve size showed no significant difference when compared to the clinically accepted annular area (p>0.05). ROC curve analysis with logistic regression comparing a multivariable algorithm that included annular size, gender discrimination and SoV mean diameter showed a higher accuracy than the annular area alone [p<0.05 for valve sizes 23, 26 and 29; p 0.1917 for valve size 20 (for valve size 20, ROC area was 0.9048 when applying annular size and 0.9455 when applying the multivariable algorithm)]. In our model, the combined use of SoV, gender and annular area resulted in improved accuracy for valve sizing.
The SoV mean diameter is a useful tool for valve selection in patients undergoing TAVR. Moreover, when SoV is used in combination with annular size and gender, accuracy to predict actual valve size increases.
STRUCTURAL: Valvular Disease: Aortic