Oversizing in transcatheter aortic valve replacement,a commonly used term but a poorly understood one: Dependency on definition and geometrical measurements |
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| Affiliation: | 1. Department of Diagnostic Radiology, University Hospital Freiburg, Freiburg, Germany;2. Department of Cardiology Namborn Hospital, Namborn, Australia;3. Department of Cardiology, University of Erlangen, Erlangen, Germany;4. Department of Cardiology, McGill University, Montreal, QB, Canada;5. Department of Cardiovascular Surgery, Munich Heart Center, Munich, Germany;6. Institute for Cardiovascular Imaging, Weill-Cornell Medical College, New York, NY, USA;7. Division of Cardiovascular Radiology, University Heart-Center Freiburg–Bad Krozingen, Germany;8. Department of Radiology, St. Paul''s Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC V6S 1Y6, Canada;1. Department of Cardiology, Takase Clinic, 885-2 Minami-orui, Takasaki 370-0036, Japan;2. Department of Radiological Technology, Takase Clinic, 885-2 Minami-orui, Takasaki 370-0036, Japan;3. Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women''s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA;1. Columbia University Medical Center/New York Presbyterian Hospital, New York, New York;1. Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey;2. Department of Radiology, Maltepe University School of Medicine, Istanbul, Turkey;3. Department of Radiology, Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey;4. Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey;5. Department of Cardiology, Dr. Siyami Ersek Thoracic & Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey;1. Cardiac Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, GRB-295, Boston, MA 02114, USA;2. Interventional Cardiology, Heart Center, Massachusetts General Hospital, Boston, MA, USA;3. Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain;4. Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA |
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| Abstract: | BackgroundIn transcatheter aortic valve replacement, prosthesis oversizing is essential to prevent paravalvular regurgitation. However, the estimated extent of oversizing strongly depends on the measurement used for annular sizing.PurposeThe aim was to investigate the influence of geometrical parameters for calculation of relative oversizing in transcatheter aortic valve replacement, reported as percentage in relation to the native annulus size, to standardize reporting.MethodsElectrocardiogram-gated cardiac dual-source CT data of 130 consecutive patients with severe aortic stenosis (mean age, 81 ± 8 years; 56 men; mean aortic valve area, 0.67 ± 0.18 cm2) were included. Aortic annulus dimensions were quantified by means of planimetry that yielded area and perimeter at the level of the basal attachment points of the aortic cusps during systole. Area- and perimeter-derived diameters were calculated as DA = 2 × √(A/π) and DP = P/π. Hypothetical prosthesis sizing was based on DA (23-mm prosthesis for 19–22 mm; 26-mm prosthesis for 22–25 mm; 29-mm prosthesis for 25–28 mm). Relative oversizing for hypothetical prosthesis selection was calculated as percentage in relation to the native annulus size.ResultsMean annulus area was 492.12 ± 94.9 mm2 and mean perimeter was 80.1 ± 7.6 mm. DP was significantly larger than DA (25.5 ± 2.4 mm vs 24.9 ± 2.4 mm; P < .001). Mean maximum diameter was 28.1 ± 3.0 mm and mean minimal diameter was 22.8 ± 2.4 mm. Calculated eccentricity index [EI = 1 − minimal diameter/maximum diameter)] was 0.19 ± 0.06. Difference between DP and DA correlated significantly with EI (r = 0.67; P < .001). Relative oversizing was 10.2% ± 3.8% and 21.6% ± 8.4% by DA and area, and 7.8% ± 3.9% by both DP and perimeter.ConclusionFor planimetric assessment of aortic annulus dimensions with CT, the percentage oversizing calculated strongly depends on the geometrical variable used for quantifying annular dimensions. Standardized nomenclature seems warranted for comparison of future studies. |
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| Keywords: | Transcatheter aortic valve replacement Computed tomography Echocardiography Oversizing |
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