Transcatheter aortic valve implantation: role of multi-detector row computed tomography to evaluate prosthesis positioning and deployment in relation to valve function

Delgado, Victoria; Ng, Arnold C.T.; Veire, Nico R. Van de; Kley, Frank van der; Schuijf, Joanne D.; Tops, Laurens F.; Weger, Arend de; Tavilla, Giuseppe; Roos, Albert de; Kroft, Lucia J.M.; Schalij, Martin J.; Bax, Jeroen J.

doi:10.1093/eurheartj/ehq018

Cited by 225 publications

(159 citation statements)

References 22 publications

(35 reference statements)

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“…21 Another study also measured the coronal and sagittal diameter of the aortic annulus on MDCT and found that MDCT-derived diameters were significantly larger than diameters measured on echocardiography. 12 On further analysis, it was also apparent that patients with low LV EF had a significantly higher LVOT diameter on TTE, probably reflecting changes concomitant with LV remodeling. These patients also had a lower LVOT VTI , as would be expected.…”

Section: Discussionmentioning

confidence: 95%

“…4 -8 Previous studies have also demonstrated that TTE underestimates AVA compared with MDCT, cardiac magnetic resonance, transesophageal echocardiography, Gorlin formula, and even surgical sizers. 8,12,[17][18][19][20] One study compared AVA from planimetry on MDCT to AVA calculated using traditional TTE and found good concordance between the 2 measurements with small underestimation of area by TTE. 18 A previous report has also demonstrated good concordance between TTE-AVA and AVA p on MDCT, with a tendency for underestimation of AVA by TTE (similar to the current study).…”

Section: Discussionmentioning

confidence: 99%

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Integration of 3D Imaging Data in the Assessment of Aortic Stenosis

O'Brien

Schoenhagen

Kapadia

et al. 2011

Circ: Cardiovascular Imaging

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Integration of 3D Imaging Data in the Assessment of Aortic Stenosis

O'Brien

Schoenhagen

Kapadia

et al. 2011

Circ: Cardiovascular Imaging

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“…The size of the valve prosthesis was selected on the basis of aortic annulus measurements obtained by TEE (first 25 patients) or by a combination of TEE and computed tomography (CT) (last 86 patients). Valve sizes of 23,26, and 29 mm were selected for aortic annuli between 18 and 21 mm, 22 and 24 mm, and 25 and 27 mm, respectively. Full balloon inflation lasted for at least three seconds during valve implantation.…”

Section: Methods Study Population and Tavi Proceduresmentioning

confidence: 99%

“…Interestingly, patients with larger recoil had a tendency to a greater Agatston calcium score in the analysis, and it is well known that the amount of valve calcification is an important predictor of significant aortic regurgitation with self-expandable and balloon-expandable valves [24][25][26] . The impact of valve calcification on the degree of recoil and paravalvular regurgitation needs to be addressed in future studies.…”

Section: Valve Haemodynamicsmentioning

confidence: 98%

Incidence, predictive factors and haemodynamic consequences of acute stent recoil following transcatheter aortic valve implantation with a balloon-expandable valve

Nombela‐Franco¹,

Ribeiro²,

Ureña³

et al. 2014

EuroIntervention

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Aims: The elastic behaviour (acute recoil) of a valve prosthesis stent following transcatheter aortic valve implantation (TAVI) is unknown. This study sought to determine the occurrence, severity, predictive factors and haemodynamic consequences of acute recoil following TAVI. Methods and results:A prospective angiographic analysis of the stent frame dimensions in 111 consecutive patients who underwent TAVI with a balloon-expandable valve (36 Edwards SAPIEN; 75 SAPIEN XT) was performed. Acute recoil was defined as the difference between minimal lumen diameter (MLD) at full balloon expansion and immediately after balloon deflation. MLD during balloon inflation was significantly larger than MLD after balloon deflation (23.40±2.31 mm vs. 22.29±2.21 mm, p<0.001), which represented an absolute and percent decrease in stent dimension of 1.10±0.40 mm and 4.70±1.76%, respectively. In the multivariate analysis, the predictors of larger recoil were a higher prosthesis/annulus ratio (r²=0.0624, p=0.015) and the SAPIEN XT prosthesis (r²=0.1276, p=0.001). No significant changes in haemodynamic performance were observed at discharge and follow-up in patients with larger recoil.Conclusions: TAVI with a balloon-expandable valve was systematically associated with a certain degree of valve stent recoil after balloon deflation. A higher degree of valve oversizing and the SAPIEN XT prosthesis predicted a larger degree of stent recoil.

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“…1,2 Although outcomes following TAVI have improved through developments in technology and increasing clinical experience, postprocedural aortic regurgitation remains relatively common and an important issue as it has been identified as an independent predictor of mortality. [3][4][5] Incongruence between device size and aortic annulus dimensions, 6,7 extensive calcification of the aortic valve [8][9][10] and prosthesis malposition [11][12][13] are considered the main causes of this phenomenon. Trivial or mild postprocedural aortic regurgitation is actually frequent, 6,[14][15][16] whereas moderate-to-severe is relatively rare, but it may be associated with increased mortality between 30 days and 1 year.…”

Section: Introductionmentioning

confidence: 99%

Impact and natural history of postprocedural aortic regurgitation on early and midterm mortality following transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis

Ielasi

Latib

Sacco

et al. 2015

Journal of Cardiovascular Medicine

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BACKGROUND: Post-procedural aortic regurgitation (AR) negatively impacts the prognosis after trans-catheter aortic valve implantation. However, data evaluating the impact of different postprocedural AR grades (particularly mild) on clinical outcomes are still important. AIM AND METHODS: A retrospective cohort analysis was performed on all consecutive patients with severe aortic stenosis who underwent trans-catheter aortic valve implantation between July 2008 and August 2011 in a single Institution. Aim of the study was to evaluate the impact of different post-procedural AR grades on early and mid-term clinical outcomes. RESULTS: 322 consecutive patients were evaluated. At postprocedural echocardiographic evaluation: 105 (32.6%) patients had no AR, 204 (63.4%) mild AR and 13 (4%) moderate/severe AR. In-hospital mortality was higher in patients with moderate/severe AR than in those with absent or mild AR (38.5% vs. 2.6%, P < 0.001). At a median clinical follow-up of 342 days [interquartile range 93-485] cardiovascular mortality was 2.9% in patients without AR; 13.2% in the mild AR group (P = 0.004 vs. absent AR) and 46.2% in the moderate/severe AR group (P < 0.001 vs. mild or absent AR). On multivariable analysis, post-procedural AR (hazard ratio = 2.65 absent vs. present any grade, 95% confidence interval = 1.11-6.29; P = 0.027) was an independent predictor of mid-term mortality. CONCLUSIONS: The impact of post-procedural AR on outcomes after trans-catheter aortic valve implantation is proportional with its grade even in case of mild post-procedural AR compared to absent. This study confirms that every effort should be made to reduce the grade of post-procedural AR after trans-catheter aortic valve implantation with current devices.

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Transcatheter aortic valve implantation: role of multi-detector row computed tomography to evaluate prosthesis positioning and deployment in relation to valve function

Cited by 225 publications

References 22 publications

Integration of 3D Imaging Data in the Assessment of Aortic Stenosis

Integration of 3D Imaging Data in the Assessment of Aortic Stenosis

Incidence, predictive factors and haemodynamic consequences of acute stent recoil following transcatheter aortic valve implantation with a balloon-expandable valve

Impact and natural history of postprocedural aortic regurgitation on early and midterm mortality following transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis

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