Three Dimensional Evaluation of the Aortic Annulus using Multislice Computer Tomography: Are Manufacturer’s Guidelines for Sizing for Percutaneous Aortic Valve Replacement Helpful?

Eur Heart J. 2009; 1(12):534

Schultz CJ, Moelker A, Piazza N, Tzikas A, Otten A, Nuis RJ, Neefjes LA, van Geuns RJ, de Feyter P, Krestin G, Serruys PW, de Jaegere PP

OBJECTIVES: To evaluate the effects of applying current sizing guidelines to different multislice computer tomography (MSCT) aortic annulus measurements on Corevalve (CRS) size selection.

METHODS: Multislice computer tomography annulus diameters [minimum: D(min); maximum: D(max); mean: D(mean) = (D(min) + D(max))/2; mean from circumference: D(circ); mean from surface area: D(CSA)] were measured in 75 patients referred for percutaneous valve replacement.

RESULTS: Fifty patients subsequently received a CRS (26 mm: n = 22; 29 mm: n = 28). D(min) and D(max) differed substantially [mean difference (95% CI) = 6.5 mm (5.7-7.2), P < 0.001]. If D(min) were used for sizing 26% of 75 patients would be ineligible (annulus too small in 23%, too large in 3%), 48% would receive a 26 mm and 12% a 29 mm CRS. If D(max) were used, 39% would be ineligible (all annuli too large), 4% would receive a 26 mm, and 52% a 29 mm CRS. Using D(mean), D(circ), or D(CSA) most patients would receive a 29 mm CRS and 11, 16, and 9% would be ineligible. In 50 patients who received a CRS operator choice corresponded best with sizing based on D(CSA) and D(mean) (76%, 74%), but undersizing occurred in 20 and 22% of which half were ineligible (annulus too large).

CONCLUSIONS: Eligibility varied substantially depending on the sizing criterion. In clinical practice both under- and oversizing were common. Industry guidelines should recognize the oval shape of the aortic annulus.

PMID: 19995874

2 Responses

  1. Paul Schoenhagen, MD  on December 12th, 2009

    Several recent CT papers have described the oval shape of the aortic annulus. This has critical importance in the context of transcatheter aortic valve implantation (TAVI), because the stent/valve is anchored at the annulus.
    This important paper described clinical implications for eligibility and device sizing.

  2. Jacobo Kirsch, MD  on December 25th, 2009

    This study shows that incorrect valve sizing based on industry guidelines to different annulus diameter measurements is a frequent occurrence. The data presented suggests that using the mean diameter may improve sizing.


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