Assessment of aortic annulus dimensions for Edwards SAPIEN Transapical Heart Valve implantation by computed tomography: calculating average diameter using a virtual ring method

Abstract

Pre-TAVI CSA assessment and average diameter calculation using a virtual ring method is able to predict the post-interventional configuration of the annulus after balloon-expandable TAVI. We regard this approach as the best-available method to select the appropriate prosthesis size for balloon-expandable TAVI. Specific MSCT-based sizing recommendations should be developed.

Patient-specific image-based computer simulation for theprediction of valve morphology and calcium displacement after TAVI with the Medtronic CoreValve and the Edwards SAPIEN valve

“…This is particularly the case for the inflow portion of the valve as this is the site where most of the complications occur, for example paravalvular regurgitation and bundle branch block and also the rare but dramatic event of coronary obstruction [7][8][9][10][11][12][13] . Most likely, the overestimation unveils limitations of the software.…”

“…With respect to the latter, one might cite as examples incomplete and/or non-circular frame expansion due to the presence of aortic root calcifications leading to paravalvular regurgitation, unexpected mobilisation of calcified leaflets leading to coronary obstruction, and dissection or rupture of the aortic root even in the presence of appropriate valve size selection [7][8][9][10][11][12][13] . Device-host interactions are clinically difficult to predict because of the large variations in the geometry and dimensions of the aortic root in addition to the variations in the amount and distribution of calcium between patients.…”

Prosthesis Oversizing in Balloon-Expandable Transcatheter Aortic Valve Implantation Is Associated With Contained Rupture of the Aortic Root

“…9 Recent studies suggest that MSCT might be more suitable to assess the aortic annulus size than 2-dimensional echocardiography. [10][11][12] With the introduction of TAVI, performing physicians and surgeons may encounter incidents and complications different from those in conventional aortic valve surgery, such as annulus or aortic root rupture and pseudoaneurysm formation of the aortic root. 8,[13][14][15] These complications may be evident while performing the procedure or may be apparent at followup studies.…”

Aortic annulus measurements: should we use multislice computed tomography, 3D echocardiography or MRI?

“…Unfortunately, doing so is not of much help either, since only few investigators looked specifically into aortic annulus measurements, and the majority of those who did, focused their attention on one imaging modality at a time [7][8][9], or at the most two, while using one of the two as a reference standard [5,12,14]. While most studies concluded that aortic annulus measurements are feasible and reproducible, and reported good intertechnique agreement, it is difficult to draw comparisons and extrapolate the published data to determine the modality of choice, because of the differences in study populations, reference standards and a variety of other factors.…”

“…Not only does it provide accurate measurements of the aortic annulus and its surrounding structures [7][8][9][10][11], it clearly depicts the origin of the coronary arteries and also allows for visualization of the entire aorta and iliac arteries, which also need to be carefully evaluated to decide on the best access strategy for TAVR (i.e., femoral approach or left ventricular apical approach). Needless to say, high quality MSCT images are associated with exposure to ionizing radiation.…”