Prosthesis sizing for transcatheter aortic valve implantation — Comparison of three dimensional transesophageal echocardiography with multislice computed tomography

Hüsser, Oliver; Holzamer, Andreas; Resch, Markus; Endemann, Dierk; Núñez, Julio; Bodı́, Vicente; Schmid, Çhristof; Riegger, Günter A.J.; Goßmann, H. H.; Hamer, Okka W.; Stroszczynski, Christian; Luchner, Andreas; Hilker, Michael; Hengstenberg, Christian

doi:10.1016/j.ijcard.2013.04.182

Cited by 64 publications

(41 citation statements)

References 22 publications

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“…An error in the 10% range that was found in these previous reports is clinically significant and potentially devastating for the patient. The current study also shows smaller measurements by 3D-TEE than by MDCT; however, the difference between 3D-TEE and MDCT measurements is ≤1%, which is much smaller than that observed in studies by Jilaihawi et al, 11 Tsang et al, 10 Husser et al, 25 or Ng et al 24 Possible reasons for the stronger correlation between 3D-TEE and MDCT measurements in the current study include the novel, off-label use of 3D-TEE software and improvements in MDCT 3D software. Particularly limiting in these previous studies was that the 3D echocardiographic analysis was performed with manual measurements on a single short-axis 3D plane.…”

Section: Discussioncontrasting

confidence: 76%

Aortic Annular Sizing Using a Novel 3-Dimensional Echocardiographic Method

Khalique

Kodali

Paradis

et al. 2014

Circ: Cardiovascular Imaging

147

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The goal of the current study is to compare a novel 3D-TEE method for annular assessment with MDCT measurements Background-Previous studies have shown cross-sectional 3-dimensional (3D) transesophageal echocardiographic (TEE) measurements to severely underestimate multidetector row computed tomographic (MDCT) measurements for the assessment of aortic annulus before transcatheter aortic valve replacement. This study compares annulus measurements from 3D-TEE using off-label use of commercially available software with MDCT measurements and assesses their ability to predict paravalvular regurgitation. Methods and Results-One hundred patients with severe, symptomatic aortic stenosis who had both contrast MDCT and 3D-TEE for annulus assessment before balloon-expandable transcatheter aortic valve replacement were analyzed. Annulus area, perimeter, and orthogonal maximum and minimum diameters were measured. Receiver operating characteristic analysis was performed with mild or greater paravalvular regurgitation as the classification variable. Three-dimensional TEE and MDCT cross-sectional perimeter and area measurements were strongly correlated (r=0.93-0.94; P<0.0001); however, the small differences (≤1%) were statistically significant (P=0.0002 and 0.0074, respectively). Discriminatory ability for ≥ mild paravalvular regurgitation was good for both MDCT (area under the curve for perimeter and area cover index=0.715 and 0.709, respectively) and 3D-TEE (area under the curve for perimeter and area cover index=0.709 and 0.694, respectively). Differences in receiver operating characteristic analysis between MDCT and 3D-TEE perimeter and area cover indexes were not statistically significant (P=0.15 and 0.35, respectively). Conclusions-Annulus

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Section: Discussioncontrasting

confidence: 76%

Aortic Annular Sizing Using a Novel 3-Dimensional Echocardiographic Method

Khalique

Kodali

Paradis

et al. 2014

Circ: Cardiovascular Imaging

147

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“…On the other hand, since available prostheses are limited to an annular size of 27 mm and since no suture material on the annular level might reduce annulus size, the use of sutureless and rapid deployment valves currently is limited to annular sizes of 19 to 27 mm. Since multislice CT may overestimate the annulus diameter, 3-dimensional transesophageal echocardiography may help for preprocedural evaluation 34. However, even with preoperative CT scan, additional intraoperative sizing is necessary after thorough resection of the native calcified aortic valve and decalcification of the aortic annulus.…”

Section: Discussionmentioning

confidence: 99%

International Expert Consensus on Sutureless and Rapid Deployment Valves in Aortic Valve Replacement Using Minimally Invasive Approaches

Glauber

Moten

Quaini

et al. 2016

Innovations�(Phila)

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Objective To define the benefit of sutureless and rapid deployment valves in current minimally invasive approaches in isolated aortic valve replacement. Methods A panel of 28 international experts with expertise in both minimally invasive aortic valve replacement and rapid deployment valves was constituted. After thorough literature review, the experts rated evidence-based recommendations in a modified Delphi approach. Results No guideline could be retrieved. Thirty-three clinical trials and 9 systematic reviews could be identified for detailed text analysis to obtain a total of 24 recommendations. After rating by the experts 12, final recommendations were identified: preoperative computed to-mographic scan as well as intraoperative transesophageal echocardiography are highly recommended. Suitable annular sizes are 19 to 27 mm. There is a contraindication for bicuspid valves only for type 0 and for annular abscess or destruction due to infective endocarditis. The use of sutureless and rapid deployment valves reduces extracorporeal circulation and aortic cross-clamp time and leads to less early complications as prolonged ventilation, blood transfusion, atrial fibrillation, pleural effusions, paravalvular leakages and aortic regurgitation, and renal replacement therapy, respectively. These clinical outcomes result in reduced intensive care unit and hospital stay and reduced costs. The use of sutureless and rapid deployment valves will lead to a higher adoption rate of minimally invasive approaches in aortic valve replacement. Respect should be taken to a necessary short learning curve for both sutureless and minimally invasive programs. Conclusions Sutureless and rapid deployment aortic valve replacement together with minimally invasive approaches offers an attractive option in aortic valve placement for patients requiring biological valve replacement.

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“…Indeed CT cannot be recommended for systematic follow-up but may provide substantial information when TTE is difficult (because of echogenicity, restrained window which is frequent in Marfan patients with orthopaedic involvement), when TTE is performed for the first time to validate the ability of this technique to follow-up the patient or when surgery is discussed. Although aortic diameter is probably an imperfect marker of the aortic risk, it remains at the present time the best validated, and the parameter used for estimating potential therapy benefit [15][16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%