Dominik Fleischmann MD, Presenter: Research support, Siemens AG Research support, General Electric Company

Catherine Dao MD, Abstract Co-Author: Nothing to Disclose

Theodore Blake MD, Abstract Co-Author: Research support, Siemens AG Research support, Employee, General Electric Company

D. Craig Miller, Abstract Co-Author: Nothing to Disclose

Michael Fischbein, Abstract Co-Author: Nothing to Disclose

William Fearon MD, Abstract Co-Author: Nothing to Disclose

to prospectively assess the ability of pre-procedural computed tomography (CT) to predict a suitable angiographic angle for device deployment and prospectively evaluate the effect of its use on contrast medium administration, fluoroscopy and procedure time.

Ninety-six patients underwent contrast enhanced or non-contrast  retrospectively gated CTA of the thoracic aorta before TAVR with the Edwards SAPIEN valve. A full 360°range of potential viewing angles - parallel to the anulus plane, and orthogonal to the anulus axis – was derived for each patient by visually aligning the nadirs of the sinuses of Valsalva in a plane that traverses through the hinges of all 3 valve cusps. In 38 patients (study group) the predicted cranio-caudal (CRA-CAU) angles were plotted as a function of the rotational (RAO-LAO) angle and provided to the treatment team prior to TAVR. Procedure time and contrast medium volume were recorded and compared to a consecutive cohort of 58 patients (control group) who had TAVR performed at our institution before CT prediction of angiographic viewing angles. The absolute difference between the predicted CRA-CAU CT angle and the actually chosen deployment angle (at a given LAO/RAO angle) was calculated for each patient.  

Mean absolute difference between the CRA-CAU angle predicted from CT and angiographic deployment angle for the 58 patients in the non-CT prediction group was 8.5° ± 8.5°, and 3.3°±3.2° in the study group. Mean procedure time (105 v. 130 minutes, p<0.01), fluoroscopy time (13 v. 18 minutes, p<0.001) and contrast volume (105 v. 144 ml, p<0.001) were all significantly decreased in the 38 patients who had CT prediction angles determined prior to TAVR compared to the preceding 58 patients who did not have pre-TAVR CT prediction. Procedure time, fluoroscopy time and contrast volume were analyzed in the historical cohort, and there was no significant decrease as the study progressed to suggest improvement in these variables from operator experience.

Pre-procedural CT accurately predicts angiographic projections for device deployment in the majority of patients and can decreases overall procedure time and contrast volume during TAVR.  

CT angle prediction may increase saftey of TAVR.

Fleischmann, D, Dao, C, Blake, T, Miller, D, Fischbein, M, Fearon, W, Computed Tomography-based Prediction of Angiographic Development Angles Reduces Contrast Medium Volume and Procedure Time for Transcatheter Aortic Valve Replacement (TAVR).  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12038242.html