TCT-673 Transcatheter Aortic Valve Oversizing: A Comparison of Leaflet Stress and Strain Distribution (original) (raw)
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Role of Multislice Computed Tomography in Transcatheter Aortic Valve Replacement
The American Journal of Cardiology, 2009
Transcatheter aortic valve replacement (TAVR) required precise knowledge of the anatomic dimensions and physical characteristics of the aortic valve, annulus, and aortic root. Most groups currently use angiography, transthoracic echocardiography (TTE), or transesophageal echocardiography (TEE) to assess aortic annulus dimensions and anatomy. However, multislice computed tomography (MSCT) may allow more detailed 3-dimensional assessment of the aortic root. Twenty-six patients referred for TAVR underwent MSCT. Scans were also obtained for 18 patients after TAVR. All patients underwent preand postprocedural aortic root angiography, TTE, and TEE. Mean differences in measured aortic annular diameters were 1.1 mm (95% confidence interval 0.5, 1.8) for calibrated angiography and TTE, ؊0.9 mm (95% confidence interval ؊1.7, ؊0.1 mm) for TTE and TEE, ؊0.3 mm (95% confidence interval ؊1.1, 0.6 mm) for MSCT (sagittal) and TTE, and ؊1.2 mm (95% confidence interval ؊2.2, ؊0.2 mm) for MSCT (sagittal) and TEE. Coronal systolic measurements using MSCT, which corresponded to angiographic orientation, were 3.2 mm (1st and 3rd quartiles 2.6, 3.9) larger than sagittal systolic measurements, which were in the same anatomic plane as standard TTE and TEE views. There was no significant association between either shape of the aortic annulus or amount of aortic valve calcium and development of perivalvular aortic regurgitation. After TAVR, the prosthesis extended to or beyond the inferior border of the left main ostium in 9 of 18 patients (50%), and in 11 patients (61%), valvular calcium was <5 mm from the left main ostium. In conclusion, MSCT identified that the aortic annulus was commonly eccentric and often oval. This may in part explain the small, but clinically insignificant, differences in measured aortic annular diameters with other imaging modalities. MSCT after TAVR showed close proximity of both the prosthesis and displaced valvular calcium to the left main ostium in most patients. Neither eccentricity nor calcific deposits appeared to contribute significantly to severity of paravalvular regurgitation after TAVR.
Journal of the American College of Cardiology, 2012
Results: The mean age in Group I was lower, 81.2Ϯ10.1 vs. 83.0Ϯ7.4 years, pϭ0.02. There was no difference between groups in Society of Thoracic Surgeons (STS) score 13.5Ϯ7.3 and 12.6Ϯ6.4, pϭ0.1, and logistic EuroSCORE 45.4Ϯ21.9 vs. 45.7Ϯ22.4, pϭ0.9, or other co-morbidities. The mean increase in aortic valve area was 0.39Ϯ0.25 in Group I vs. 0.37Ϯ0.26 in Group II, pϭ0.46. BAV was unsuccessful in 35 (14.4%) in Group I and in 46 (19.0%) in Group II, pϭ0.18. Multivariable analysis (including time period, balloon size, number inflation, aortic valve area, ejection fraction, repeat procedure) detected repeated BAV procedures [HR 4.34 (95% CI 2.2-8.3), p Ͻ0.001] as the strongest correlate for unsuccessful BAV. Serious vascular complications occurred less in the latest period (Ͼ2010 vs. Ͻ2010). (Table). Conclusions: Recent improvements in technique and device have not led to higher success in BAV procedures; but has led to a reduction in complication rates. Repeat BAV procedures are associated with lower success rates.
The American Journal of Cardiology, 2011
Location of aortic valve calcium (AVC) can be better visualized on contrast-enhanced multidetector row computed tomography. The present evaluation examined whether AVC severity and its location could influence paravalvular aortic regurgitation (AR) after transcatheter aortic valve implantation. A total of 79 patients (age 80 ؎ 7 years, 49% men) with preprocedural multidetector row computed tomography were included. Volumetric AVC quantification and its location were assessed. Transesophageal echocardiography was performed to assess the presence and site of AR after transcatheter aortic valve implantation. Receiver operating characteristic curves were generated to evaluate the usefulness of AVC in determining paravalvular AR at a specific site. Postprocedural AR of grade 1 or more was observed in 63 patients. In most patients (n ؍ 56, 71%), AR was of paravalvular origin. Calcium at the aortic wall of each valve cusp had the largest area under the curve (0.93, p <0.001) in predicting paravalvular AR at the aortic wall site compared to calcium at the valvular edge or body (area under the curve 0.58 and 0.67, respectively). Calcium at the valvular commissure was better than calcium at the valvular edge (area under the curve 0.94 vs 0.71) in predicting paravavular AR originating from the corresponding commissure. In conclusion, contrast-enhanced multidetector row computed tomography can be performed to quantify AVC. Both AVC severity and its exact location are important in determining paravalvular AR after transcatheter aortic valve implantation.
The International Journal of Cardiovascular Imaging, 2013
Cardiac computed tomography (CT) allows accurate and detailed analysis of the anatomy of the aortic root and valve, including quantification of calcium. We evaluated the correlation between different CT parameters and the degree of post-procedural aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) using the balloon-expandable Edwards Sapien prosthesis. Preintervention contrast-enhanced dual source CT data sets of 105 consecutive patients (48 males, mean age 81 ± 6 years, mean logEuroSCORE 34 ± 13 %) with symptomatic severe aortic valve stenosis referred for TAVI using the Edwards Sapien prosthesis (Edwards lifesciences, Inc., CA, USA) were analysed. The degrees of aortic valve commissural calcification and annular calcification were visually assessed on a scale from 0 to 3. Furthermore, the degree of aortic valve calcification as quantified by the Agatston score, aortic annulus eccentricity, aortic diameter at the level of the sinus of valsalva and at the sinotubular junction were assessed. Early post-procedural AR was assessed using aortography. Significant AR was defined as angiographic AR of at least moderate degree (AR C 2). Visual assessment of the degree of aortic annular calcification as well as the Agatston score of aortic valve calcium correlated weakly, yet significantly with the degree of post-procedural AR (r = 0.31 and 0.24, p = 0.001 and 0.013, respectively). Compared to patients with AR \ 2, patients with AR C 2 showed more severe calcification of the aortic annulus (mean visual scores 1.9 ± 0.6 vs. 1.5 ± 0.6, p = 0.003) as well as higher aortic valve Agatston scores (1,517 ± 861 vs. 1,062 ± 688, p = 0.005). Visual score for commissural calcification did not differ significantly between both groups (mean scores 2.4 ± 0.5 vs. 2.5 ± 0.5, respectively, p = 0.117). No significant correlation was observed between the degree of AR and commissural calcification, aortic annulus eccentricity index or aortic diameters. The extent of aortic valve annular calcification, but not of commissural calcification, predicts significant post-procedural AR in patients referred for TAVI using the balloon-expandable Edwards Sapiens prosthesis.
Multidetector Computed Tomography in Transcatheter Aortic Valve Implantation
JACC: Cardiovascular Imaging, 2011
Aortic stenosis is a common disorder. Aortic valve replacement is indicated in symptomatic patients with severe aortic stenosis, as the prognosis of untreated patients is poor. Nevertheless, many patients pose a prohibitively high surgical risk and are not candidates for surgical valve replacement. Transcatheter aortic valve implantation (TAVI) is a novel method to treat selected high-risk patients with aortic stenosis. Patient screening and anatomic measurements of the aortic root are of great importance to ensure procedural success and appropriate patient selection. Multidetector computed tomography (CT) is playing an increasingly important role in patient screening protocols before TAVI, provides detailed anatomic assessment of the aortic root and valve annulus, assesses the suitability of iliofemoral access, and determines appropriate coaxial angles to optimize the valve implantation procedure. Additionally, CT is providing a greater understanding of mediumterm valve durability and integrity. This review outlines an evolving role for CT angiography in support of a TAVI program and describe step by step how CT can be used to enhance the procedure and provide a practical guide for the utilization of CT angiography in support of a transcatheter aortic valve program.
Impact of Aortic Regurgitation After Transcatheter Aortic Valve Implantation
JACC: Cardiovascular Imaging, 2012
Understanding the severity of aortic regurgitation (AR) after transcatheter aortic valve implantation, its impact on left ventricular (LV) structure and function, and the structural factors associated with worsening AR could lead to improvements in patient selection, implantation technique, and valve design. B A C K G R O U N D Initial studies in patients at high risk of surgical aortic valve replacement have reported both central valvular and paravalvular AR after transcatheter aortic valve implantation. M E T H O D S Transthoracic echocardiograms were quantified from 95 patients in the REVIVAL (TRanscatheter EndoVascular Implantation of VALves) trial. Transthoracic echocardiograms were obtained before implantation of the Edwards-Sapien valve (Edwards Lifesciences, Irvine, California) and thereafter at selected intervals. Measurements included LV internal diameters and volumes, ejection fraction, aortic valve area, and the degree of aortic regurgitation. Measures of degree of native leaflet mobility, thickness, and calcification, as well as left ventricular outflow tract, aortic annulus, and aortic root diameters were also made.
Journal of Medical Imaging and Radiation Oncology, 2019
IntroductionPatients with severe aortic stenosis (AS) require multi‐detector computed tomography (MDCT) when considered for transcatheter aortic valve implantation (TAVI). Incidental findings on MDCT are common given the age group and region imaged. Our aim was to evaluate the frequency and outcome of incidental findings (IF) identified on MDCT and the impact on survival.MethodsThis single‐centre analysis retrospectively reviewed severe AS patients who underwent MDCT during TAVI workup. MDCT reports were reviewed for any IF and defined into three categories: IF of no relevant clinical significance (IF‐NoCS), IF of non‐immediate clinical significance (IF‐NICS) and IF of immediate clinical significance (IF‐ICS). Demographics, follow‐up of IF and survival were calculated from MDCT date.ResultsTwo hundred and sixty‐five patients underwent MDCT for TAVI suitability (mean age 83 ± 6 years, 52% male). The majority proceeded to TAVI (65%). Renal lesions (25%) and lung nodules (18%) were the...