Borek Foldyna, Presenter: Nothing to Disclose

Martin Haensig, Abstract Co-Author: Nothing to Disclose

Christian Luecke MD, Abstract Co-Author: Nothing to Disclose

David Holzhey, Abstract Co-Author: Nothing to Disclose

Claudia Andres, Abstract Co-Author: Nothing to Disclose

Matthias Grothoff MD, Abstract Co-Author: Nothing to Disclose

Friedrich-Wilhelm Mohr, Abstract Co-Author: Nothing to Disclose

Matthias Gutberlet MD, PhD, Abstract Co-Author: Nothing to Disclose

Lukas H. J. Lehmkuhl MD, Abstract Co-Author: Nothing to Disclose

To analyze the angle between left ventricular long axis and the outflow tract (αLV-LVOT) on cardiac computed tomography (CT) and to describe its impact on occurrence of paravalvular leakage (PL), fluoroscopy time and postoperative CK-MB levels in transapical aortic valve implantation (TA-AVI).

High-risk patients with severe aortic stenosis, scheduled for TA-AVI using an Edwards-SAPIENTM prosthesis were retrospectively included. The αLV-LVOT was measured on CT during systole and diastole as far as retrospectively gated data sets were available. The αLV-LVOT was correlated with the occurrence of PL, total fluoroscopy time and postoperative CK-MB levels. Inter-observer variability was assessed in all cases.

Eighty-two patients with an average age of 81.9±5.7 years were included in the study (females/males 57/25 [69.5%/30,5%]). The mean αLV-LVOTs were 61.4°±9.7° and 61.0°±10.2° during systole and diastole, respectively. There was a minimal, non-significant change in the αLV-LVOT between systole and diastole of 0.1°±4.2°(p=0.85). PL was found in 39 patients (0°=43[52.4%];I°=30[36.6%];II°=9[11.0%]). Patients with a clinically significant PL (≥II°) showed a significantly steeper mean αLV-LVOT than patients with I° or without PL (mean difference: 13.8±3.3°;p<0.001). There was no significant correlation between the αLV-LVOT and total fluoroscopy time (r=-0.18,p=0.12), and there was a trend toward a small correlation with postoperative CK-MB levels (r=0.21,p=0.06).

During TA-AVI, steeper αLV-LVOTs were associated with significantly higher grades of PL. Thus, the αLV-LVOT might influence the selection of the transapical implantation path and could have a significant impact on designs for future stents or novel delivery devices.

The greater αLV-LVOTs were associated with significantly higher grades of PL and might influence the selection of the transapical implantation path.

Foldyna, B, Haensig, M, Luecke, C, Holzhey, D, Andres, C, Grothoff, M, Mohr, F, Gutberlet, M, Lehmkuhl, L, Is the Access Path Angle in Transapical Aortic Valve Implantation a Risk Factor for the Occurrence of Postprocedural Paravalvular Leakage?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14012496.html