3-Dimensional Aortic Annular Assessment by Multidetector Computed Tomography Predicts Moderate or Severe Paravalvular Regurgitation After Transcatheter Aortic Valve Replacement A Multicenter Retrospective Analysis

OBJECTIVES: This study sought to analyze multidetector computed tomography (MDCT) 3-dimensional aortic annular dimensions for the prediction of paravalvular aortic regurgitation (PAR) following transcatheter aortic valve replacement (TAVR). Moderate or severe PAR after TAVR is associated with increased morbidity and mortality.

METHODS: A total of 109 consecutive patients underwent MDCT pre-TAVR with a balloon expandable aortic valve. Differences between transcatheter heart valve (THV) size and MDCT measures of annular size (mean diameter, area, and circumference) were analyzed concerning prediction of PAR. Patients with THV malposition (n = 7) were excluded. In 50 patients, MDCT was repeated after TAVR to assess THV eccentricity (1 – short diameter/long diameter) and expansion (MDCT measured THV area/nominal THV area).

RESULTS: Moderate or severe PAR (13 of 102) was associated with THV undersizing (THV diameter – mean diameter = -0.7 ± 1.4 mm vs. 0.9 ± 1.8 mm for trivial to mild PAR, p < 0.01). The difference between THV size and MDCT annular size was predictive of PAR (mean diameter: area under the curve [AUC]: 0.81, 95% confidence interval [CI]: 0.68 to 0.88; area: AUC: 0.80, 95% CI: 0.65 to 0.90; circumference: AUC: 0.76, 95% CI: 0.59 to 0.91). Annular eccentricity was not associated with PAR (AUC: 0.58, 95% CI: 0.46 to 0.75). We found that 35.3% (36 of 102) and 45.1% (46 of 102) of THVs were undersized relative to the MDCT mean diameter and area, respectively. THV oversizing relative to the annular area was not associated with THV eccentricity or underexpansion (oversized vs. undersized THVs; expansion: 102.7 ± 5.3% vs. 106.1 ± 5.6%, p = 0.03; eccentricity: median: 1.7% [interquartile range: 1.4% to 3.0%] vs. 1.7% [interquartile range: 1.1% to 2.7%], p = 0.28).

CONCLUSIONS: MDCT-derived 3-dimensional aortic annular measurements are predictive of moderate or severe PAR following TAVR. Oversizing of THVs may reduce the risk of moderate or severe PAR.

PMID: 22365423

Posted in Magnetic Resonance Imaging and tagged , , , , , .

2 Comments

  1. See also:

    Cross-Sectional Computed Tomographic Assessment Improves Accuracy of Aortic Annular Sizing for Transcatheter Aortic Valve Replacement and Reduces the Incidence of Paravalvular Aortic Regurgitation.
    Jilaihawi H, Kashif M, Fontana G, Furugen A, Shiota T, Friede G, Makhija R, Doctor N, Leon MB, Makkar RR.
    J Am Coll Cardiol. 2012 Feb 7.
    PMID: 22365424 http://www.ncbi.nlm.nih.gov/pubmed/22365424

  2. Also:

    Comparison of two-dimensional and three-dimensional imaging techniques for measurement of aortic annulus diameters before transcatheter aortic valve implantation.
    Altiok E, Koos R, Schröder J, Brehmer K, Hamada S, Becker M, Mahnken AH, Almalla M, Dohmen G, Autschbach R, Marx N, Hoffmann R.
    Heart. 2011 Oct;97(19):1578-84. Epub 2011 Jun 23.
    PMID: 21700756 http://www.ncbi.nlm.nih.gov/pubmed/21700756

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