Philipp Blanke MD, Presenter: Nothing to Disclose

Maximilian Russe, Abstract Co-Author: Nothing to Disclose

Jonathan Avrom Leipsic MD, Abstract Co-Author: Speakers Bureau, General Electric Company Speakers Bureau, Edwards Lifesciences Corporation Medical Advisory Board, General Electric Company Medical Advisory Board, Edwards Lifesciences Corporation

Ullrich Ebersberger MD, Abstract Co-Author: Nothing to Disclose

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

U. Joseph Schoepf MD, Abstract Co-Author: Research Consultant, Bayer AG Research Grant, Bayer AG Research Consultant, Bracco Group Research Grant, Bracco Group Research Consultant, General Electric Company Research Grant, General Electric Company Research Consultant, Siemens AG Research Grant, Siemens AG

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

Pal Suranyi MD, PhD, Abstract Co-Author: Nothing to Disclose

To investigate pulsatile changes of the aortic annulus and their impact on prosthesis selection by computed tomography (CT) as precise non-invasive prosthesis sizing is a prerequisite for transcatheter aortic valve replacement (TAVR).  

110 patients with severe aortic stenosis (mean age 82.9±8 years, mean aortic valve area 0.69±0.18cm2) underwent ECG-gated CT. Aortic annulus dimensions were planimetrically quantified as area-derived (DA=2x√(CSA/π)) and perimeter-derived (DP=P/π) diameter in 5%-increments of RR. Hypothetical prosthesis sizing was based on DA and DP (23mm prosthesis for <22mm; 26mm: 22-25mm; 29mm: >25mm) and compared between maximum and traditional cardiac CT reconstruction phases at 35% and 75% of RR. Agreement for prosthesis selection was calculated by κ-statistics.

DA and DP were increased and eccentricity was reduced during systole, with DA-MAX and DP-MAX most often observed at 20% of RR. DP was consistently larger than DA. Average net differences were 2.0±0.6mm and 1.7±0.5mm by DA-MIN vs. DA-MAX and DP-MIN vs. DP-MAX. Agreement for prosthesis sizing was found in 93/110 patients (κ=0.75) by DA-75% and in 80/110 patients (κ=0.53) by DA-MAX compared to DA-35%; and in 94/110 patients (κ=0.73) by DP-75% and in 93/110 patients (κ=0.73) by DP-MAX compared to DP-35%. With sizing by DA-75% or DP-75% nominal prosthesis diameter was smaller than DA-MAX or DP-MAX in 15 and 6 patients.

Aortic annulus morphology exhibits conformational pulsatile changes throughout the cardiac cycle due to deformation and stretch. These changes affect prosthesis selection. Prosthesis selection by diastolic perimeter- or area-derived dimensions harbors the risk of undersizing.

Conformational pulsatile changes of the aortic annulus have to be considered as these may effect prosthesis selection. CT-based measurements should be obtained during systole to avoid undersizing.

Blanke, P, Russe, M, Leipsic, J, Ebersberger, U, Langer, M, Schoepf, U, Pache, G, Suranyi, P, Conformational Pulsatile Changes of the Aortic Annulus: Impact on Prosthesis Sizing by Computed Tomography for Transcatheter Aortic Valve Replacement  .  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12032477.html