Computed Tomographic Imaging of Transcatheter Aortic Valve Replacement for Prediction and Prevention of Procedural Complications

Leipsic, Jonathon; Yang, Tae–Hyun; Min, James K.

doi:10.1161/circimaging.113.000334

Cited by 17 publications

(9 citation statements)

References 39 publications

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“…In addition, high mechanical stresses over TAV leaflets may induce enhanced tissue degeneration and reduce long-term valve durability 2, 4, 28, 130 . On the contrary, some studies show that the relationship between non-circular deployment and paravalvular leak is not conclusive 71, 153 . In a case-report, Jilaihawi et al 53 noted that TAV under-expansion can lead to good hemodynamic function and excellent symptomatic recovery.…”

Section: Introductionmentioning

confidence: 99%

“…They also noted that the eccentric TAV deployment may result in an asymmetric systolic jet with elevated turbulence and shear stress downstream of the valve; however, this phenomenon may not be significant enough to induce blood damage 43 . While TAV oversizing can be used as a solution to compensate for eccentric TAV deployment, many studies have shown that oversizing contributes to annular injury or even rupture 71, 79 . Oversizing by specific percentages optimizes risk/benefit ratio in terms of paravalvular leakage and conduction disorders 47, 69, 77 .…”

Section: Introductionmentioning

confidence: 99%

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On the Mechanics of Transcatheter Aortic Valve Replacement

et al. 2016

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Transcatheter aortic valves (TAVs) represent the latest advances in prosthetic heart valve technology. TAVs are truly transformational as they bring the benefit of heart valve replacement to patients that would otherwise not be operated on. Nevertheless, like any new device technology, the high expectations are dampened with growing concerns arising from frequent complications that develop in patients, indicating that the technology is far from being mature. Some of the most common complications that plague current TAV devices include malpositioning, crimp-induced leaflet damage, paravalvular leak, thrombosis, conduction abnormalities and prosthesis-patient mismatch. In this article, we provide an in-depth review of the current state-of-the-art pertaining the mechanics of TAVs while highlighting various studies guiding clinicians, regulatory agencies, and next-generation device designers.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

On the Mechanics of Transcatheter Aortic Valve Replacement

et al. 2016

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“…Based on automatically detected lowest point of each aortic sinus, the system displays a graphical guiding‐tool to obtain an exact perpendicular fluoroscopic C‐arm view onto the aortic annulus to allow for optimal aortic valve implantation . Exciting advances in fusion imaging, such as the HeartNavigator (Koninklijke Philips N. V., Amsterdam, Netherlands) allow the incorporation of pre‐procedural MDCT data with on table fluoroscopic image registration to optimize TAVR implantation . Pre‐operative MDCT data could be imported into the system prior to TAVR.…”

Section: Clinical Applications Of Mdct In Structural Heart Interventionsmentioning

confidence: 99%

“…19 Exciting advances in fusion imaging, such as the HeartNavigator (Koninklijke Philips N. V., Amsterdam, Netherlands) allow the incorporation of pre-procedural MDCT data with on table fluoroscopic image registration to optimize TAVR implantation. 20,21 Pre-operative MDCT data could be imported into the system prior to TAVR. The MDCT data are automatically segmented to identify the aortic root, the coronary ostia, the aortic valve and the aortic annulus.…”

Section: Clinical Applications Of Mdct In Structural Heart Interventionsmentioning

confidence: 99%

Clinical utility of multi‐detector cardiac computed tomography in structural heart interventions

Gooley

Seneviratne

et al. 2016

J Med Imag Rad Onc

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In recent years, there have been major advances in structural interventional cardiology, which have revolutionized the practice of cardiology. Appropriate selection and follow-up of patients undergoing these structural heart interventions is vital. Multi-detector computed tomography (MDCT) has emerged as a key imaging modality in the peri-procedural assessment of patients undergoing multiple structural cardiac interventions. The purpose of this review is to provide an evidence-based clinical update on the roles of MDCT in both established and evolving structural heart interventions, including transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve implantation (TMVI). The utility of MDCT in the peri-procedural assessment of patients undergoing pulmonary vein isolation (PVI) for atrial fibrillation, cardiac resynchronization therapy (CRT) and left atrial appendage (LAA) closure will also be reviewed.

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“…Safety of the procedure depends on, among others, correct positioning of the bioprosthesis since inaccurate or incorrect positioning may lead to a number of complications such as conduction disorders, paravalvular leakage and valve embolization [6] . Proper selection of the C-arm angulation in which the three aortic sinuses are depicted on one single line in the sequence of posterior, right and left sinus, the optimal angiographic projection (OAP), by contrast angiography during TAVI is essential [7][8][9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

Definition of the aortic valve plane by means of a novel dedicated software program: Proof of concept and validation with multi slice computed tomography

Faquir

Rahhab

Schultz

et al. 2016

IJDI

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Background: Proper selection of the C-arm angulation during transcatheter aortic valve implantation (TAVI) is essential. Currently multi slice computed tomography (MSCT) is increasingly used to determine the C-arm angulation and is considered the gold standard. Yet, MSCT is not available in the catheterization laboratory and requires expertise. We sought to evaluate the accuracy of a novel software providing the optimal angiographic projection (i.e. three cusps on one line, equally in size and posterior, right and left cusp sequence-optimal angiographic projection [OAP]) based on two contrast angiograms.Methods: Software was validated by comparing the difference in OAP between MSCT (reference) and software (CAAS A-Valve) in 67 patients and by qualitative comparison of the aortograms performed in accordance to MSCT and CAAS A-Valve defined OAP in 20 patients by 2 blinded assessors. Results:The median (IQR) difference in the OAP between MSCT and software was 12.4 (7.5-20.1) and 18.9 (10.8-28.5) degrees. For the qualitative comparison, an overall score ≥ 2 (acceptable-perfect) of 90% was reached by both observers for OAP derived by MSCT. It was 85% and 90% (observer 1 and 2) for OAP derived from the software and was 90% after consensus. The interobserver variability (mean difference and SD) for assessment of OAP curve and OAP itself was 1.6 (SD = 5.8, p = .23) and 9.5 (SD = 18.4) degrees (p = .03) respectively. Conclusions:The CAAS A-Valve software adequately defines the OAP and is clinically useful in patients who do not have a MSCT prior to TAVI.

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Computed Tomographic Imaging of Transcatheter Aortic Valve Replacement for Prediction and Prevention of Procedural Complications

Cited by 17 publications

References 39 publications

On the Mechanics of Transcatheter Aortic Valve Replacement

On the Mechanics of Transcatheter Aortic Valve Replacement

Clinical utility of multi‐detector cardiac computed tomography in structural heart interventions

Definition of the aortic valve plane by means of a novel dedicated software program: Proof of concept and validation with multi slice computed tomography

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