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Accuracy of aortic annular sizing for TAVR improved by cross-sectional CT assessment
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Three-dimensional cross-sectional measurements of the aortic annulus have been found to be superior to conventional 2-D echocardiographic sizing in the discrimination of patients with paravalvular regurgitation.
Research by Hasan Jilaihawi, MD, of Cedars-Sinai Medical Center, Los Angeles, and colleagues found that CT cross-sectional aortic annulus assessment affects device sizing and patient selection. Improved accuracy in aortic annulus sizing leads to reduced incidence of post-transcatheter aortic valve replacement (TAVR; Edwards Sapien, Edwards Lifesciences) paravalvular aortic regurgitation.
Patients were enrolled into the study by a single center to the US PARTNER trial (n=136). There were 96 patients in the 2-D transesophageal echocardiography-guided (TEE-guided) annular sizing group and 40 in the cross-sectional CT-guided annular sizing group.
Researchers compared the discriminatory value of multiple CT annular measures for post-TAVR paravalvular aortic regurgitation with 2-D echocardiographic measures. Also studied were TAVR outcomes with device selection according to aortic annular sizing using the 2-D TEE-guided approach and the CT-guided approach.
Annular dimensions derived from the CT-guided annular sizing approach were highly correlated with paravalvular regurgitation. The prospective application of CT-guided annular sizing approach significantly reduced the incidence of paravalvular aortic regurgitation grade worse than mild after TAVR (7.5% vs. 21.9%; P=.045).
“Our data lend strong support to 3-dimensional cross-sectional measures, using CT as the new gold standard for aortic annular evaluation for TAVR with the Edwards SAPIEN device,” the researchers wrote. “This study demonstrates for the first time CT cross-sectional annular assessment for TAVR sizing is superior to 2-D TEE assessment in reducing paravalvular aortic regurgitation.”
Disclosure: Dr. Jilaihawi is a consultant to Edwards Lifesciences, St. Jude Medical and Venus Medtech. See the full study for relevant financial disclosures from the rest of the research group.
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