Philipp Blanke, Presenter: Nothing to Disclose

Gregor Pache MD, Abstract Co-Author: Nothing to Disclose

Jochen Reinoehl, Abstract Co-Author: Nothing to Disclose

Stefan Bulla MD, Abstract Co-Author: Nothing to Disclose

Christian Schlensak, Abstract Co-Author: Nothing to Disclose

Mathias F. J. Langer MD, PhD, Abstract Co-Author: Nothing to Disclose

To retrospectively investigate the prevalance of pseudoaneurysm formation of the aortic root in ballon-expandable TAVI and to investigate the potential cause by means of pre- and post-interventional MSCT.

In this institutional review board-approved study 56 patients (mean age 79±9 years, mean aortice valve area 0.67±0.19cm2) underwent ballon-expandable TAVI using the EdwardsSAPIEN Transcatheter Heart Valve (23mm, n=16; 26 mm, n=40). Employing MSCT, we quantified aortic annulus dimensions by cross-sectional area (CSA) assessment and average diameter calculation (CAAD) prior and after TAVI. In the first 31 patients (group A) prosthesis sizing was based on TEE measurements (23mm prosthesis for TEE ≤21mm), in the succeeding 25 patients (group B) prosthesis sizing was based on MSCT measurements (23mm prosthesis for CAAD ≤22mm).

Post-TAVI MSCT data sets were available in 51 patients. Pre-TAVI CAAD was 22.9±1.6mm; post-TAVI CAAD was 22.9±1.2mm. Median relative change in CAAD was -0.1% (IQR 3.3%). With CAAD as standard of reference, 5 patients were oversized in group A (TEE>21 mm, CAAD<22 mm, 26mm prosthesis) and showed a relative increase of CAAD >6%, of whom two patients were diagnosed with pseudoaneurysm formation. Relative increase of CAAD >6% and pseudoaneurysm formation was not observed in group B. Relationship of TEE as imaging modality for prosthesis sizing as well as association of oversizing and occurence of pseudoaneurysm formation were significant (p=0.044 and p=0.008, Fisher exact test).

Prosthesis oversizing in ballon-expandable TAVI is associated significantly with pseudoaneurysm formation of the aortic root due to relevant increase in CAAD. MSCT-based assessment of aortic annulus dimension can reduce the incidence of prosthesis oversizing.

Computed tomography-based planimetric assessment should be considered for prosthesis sizing in balloon-expandable TAVI as it may reduce the incidence of oversizing and aortic root pseudoaneurysm.

Blanke, P, Pache, G, Reinoehl, J, Bulla, S, Schlensak, C, Langer, M, Prosthesis Oversizing in Balloon-expandable Transcatheter Aortic Valve Implantation Is Associated with Pseudoaneurysm Formation of the Aortic Root.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11014877.html