Aortic Annulus Evaluation in Transcatheter Aortic Valve Implantation

Catheter Cardiovasc Interv. 2010; 76(1):153-155

Hutter A, Opitz A, Bleiziffer S, Ruge H, Hettich I, Mazzitelli D, Will A, Tassani P, Bauernschmitt R, Lange R

OBJECTIVES: We compared the annulus diameters measured by transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) and dual-source computed tomography (DSCT) prior to transcatheter aortic valve implantation (TAVI). In TAVI correct evaluation of the aortic annulus is mandatory in order to choose the correct prosthesis type and size and to prevent complications. There is no gold standard for the assessment of aortic annulus diameters.

METHODS: Preoperative assessment of the aortic annulus with TTE, TEE and DSCT was performed in 187 consecutive patients referred for TAVI between 06/2007 and 05/2009.

RESULTS: The mean aortic annuli were 22.6+/-2.0mm measured with DSCT, 22.3+/-2.5mm with TTE and 22.9+/-2.2mm with TEE. Despite a strong correlation between the measurement techniques relevant statistical spread occurred with differences up to 3mm in all measurement methods. Inter- and intra-observer variability was good for TEE and less satisfactory for DSCT measurements. TEE measurements taken as decisive parameter for the implantation changed the implantation strategy in 15,5% of patients and did not show an increased rate of procedural complications.

CONCLUSION: Despite a strong correlation, the measurement techniques for the aortic annulus show relevant statistical spread, consequently one measurement technique cannot definitely predict another. TEE measurements show a more satisfactory intra- and inter-observer variability than DSCT. Taking TEE annulus measurements as decisive parameter for the implantation has an impact on the implantation strategy and is safe with a low rate of procedural complications.

PMID: 20518012

One Response

  1. Paul Schoenhagen  on June 29th, 2010

    see also:
    Delgado V, Ng AC, Schuijf JD, van der Kley F, Shanks M, Tops LF, van de Veire NR, de Roos A, Kroft LJ, Schalij MJ, Bax JJ. Automated assessment of the aortic root dimensions with multidetector row computed tomography.
    Ann Thorac Surg. 2011 Mar;91(3):716-23.
    PMID: 21352985

    See the post from January 12, 2010:

    Multimodal Assessment of the Aortic Annulus Diameter: Implications for Transcatheter Aortic Valve Implantation.
    David Messika-Zeitoun, Jean-Michel Serfaty, Eric Brochet, Gregory Ducrocq, Laurent Lepage, Delphine Detaint, Fabien Hyafil, Dominique Himbert, Nicoletta Pasi, Jean-Pierre Laissy, Bernard Iung, Alec Vahanian.
    J Am Coll Cardiol. 2010; 55(1):186-194.
    PMID: 20117398


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