Elham Najafpour MD, Presenter: Nothing to Disclose

Sreevathsan Sridhar MD, Abstract Co-Author: Nothing to Disclose

Daniel Vargas MD, Abstract Co-Author: Nothing to Disclose

Saman Panahipour MD, Abstract Co-Author: Nothing to Disclose

Alan Zajarias MD, Abstract Co-Author: Nothing to Disclose

Cylen Javidan-Nejad MD, Abstract Co-Author: Nothing to Disclose

Trans-catheter aortic valve replacement (TAVR) is increasingly performed to treat severe aortic stenosis. Pre-TAVR chest, abdomen & pelvis CT frequently yields incidental findings with a potential to impact surgical planning.

Pre-procedural CT exams of 285 consecutive patients considered for TAVR were retrospectively reviewed. Incidental findings were categorized as: Group 1) acute incidental finding needing treatment (e.g. pneumonia); Group 2) malignancy; Group 3) comorbidity (e.g. cirrhosis); Group 4) non-acute incidental finding needing further work up or follow-up; Group 5) incidental finding of no consequence. Clinical notes before & after pre-TAVR CTs were reviewed to assess which incidental finding was already known and to determine which patients underwent treatment by TAVR, traditional surgery (TS) & balloon valvuloplasty (BV). Those who were not treated based on the incidental findings discovered by CT (NT) were differentiated from those decided to not be treated due to other factors. Statistical analysis was performed using chi-square.    

6/285 CT exams revealed no incidental findings. Most CT studies showed multiple incidental findings falling into several groups. Group 1: 35 incidental findings, 60% were unknown, 50% patients had TAVR, 26% TS, 9% BV & 6% NT; Group 2: 16 incidental findings, 94% were unknown, 44% patients had TAVR, 6% TS, 13% BV & 25% NT; Group 3: 284 incidental findings, 29% were unknown, 45% patients had TAVR, 25% TS, 2% BV & 4% NT; Group 4: 166 incidental findings, 45% patients had TAVR, 18% TS, 3% BV, & 4% NT; Group 5: 372 incidental findings, 44% patients had TAVR, 24% TS, 3% BV, 3% NT. Statistical analysis revealed a higher association the incidental finding of cancer with a management of no repair (p 0.0005). All other correlations had a p value > 0.05.    

Incidental findings are ubiquitous on pre-TAVR CT exams. Cancer is the only incidental finding demonstrating a significant association with the decision to not perform an interventional treatment. Comorbidities which may have precluded patients from open aortic valve replacement in the past now have no significant effect upon decision to treat by TAVR.  

This study can lead to establishment of standardized reporting of incidental findings in regards to a vascular procedure (Similar to Bi-RADS).  

Najafpour, E, Sridhar, S, Vargas, D, Panahipour, S, Zajarias, A, Javidan-Nejad, C, Do Incidental Findings Discovered on Pre-procedural CT for Trans-catheter Aortic Valve Replacement Have an Impact on Decision to Treat Aortic Stenosis?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005344.html