Cross-Sectional Computed Tomographic Assessment Improves Accuracy of Aortic Annular Sizing for Transcatheter Aortic Valve Replacement and Reduces the Incidence of Paravalvular Aortic Regurgitation

Abstract

Our data lend strong support to 3-dimensional cross-sectional measures, using CT as the new gold standard for aortic annular evaluation for TAVR with the Edwards SAPIEN device.

Transcatheter Aortic Valve Implantation (TAVI) for Aortic Stenosis

“…The multidisciplinary team approach is critical for each of these stages. Multimodality imaging 17,[57][58] employing catheter angiogram, echocardiographic, multi-detector CT and cardiac MRI techniques is becoming the standard approach for anatomical modelling prior to TaVI. Transthoracic and transoesphageal echocardiograms underestimated aortic annulus dimensions due to the limitation of imaging in a single plane thereby contributing to annulus-prosthesis mismatch and hence paravalvular aR.…”

“…Transthoracic and transoesphageal echocardiograms underestimated aortic annulus dimensions due to the limitation of imaging in a single plane thereby contributing to annulus-prosthesis mismatch and hence paravalvular aR. 17,57,58 Thus, cardiac CT has become the favoured standard for annular sizing. In native TaVI patients, cardiac MRI was reported by Jabbour et al 17 to be reliable and equally reproducible to CT and superior to TTE.…”

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

“…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.…”

“…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.…”

Evaluation of Non-Contact Sampling and Detection of Explosives using Receiver Operating Characteristic Curves

“…Receiver operating characteristic curves were developed by the U.S. military to differentiate radar signals and noise [194,195] and the use of ROC curves as an sensor performance evaluation tool has grown in popularity for use in medical diagnostic testing [196][197][198][199]. The medical field used ROC curves as a method to quantify how accurately the use of instrumental tools was able to make discriminations between two conditions or diagnosis [200].…”