CT-Angiography–Based Evaluation of the Aortic Annulus for Prosthesis Sizing in Transcatheter Aortic Valve Implantation (TAVI)–Predictive Value and Optimal Thresholds for Major Anatomic Parameters
Authors:Florian Schwarz mail, Philipp Lange, Dominik Zinsser, Martin Greif, Peter Boekstegers, Christoph Schmitz, Maximilian F. Reiser, Christian Kupatt, Hans C. Becker
Background/Objectives
To evaluate the predictive value of CT-derived measurements of the aortic annulus for prosthesis sizing in transcatheter aortic valve implantation (TAVI) and to calculate optimal cutoff values for the selection of various prosthesis sizes.
Methods
The local IRB waived approval for this single-center retrospective analysis. Of 441 consecutive TAVI-patients, 90 were excluded (death within 30 days: 13; more than mild aortic regurgitation: 10; other reasons: 67). In the remaining 351 patients, the CoreValve (Medtronic) and the Edwards Sapien XT valve (Edwards Lifesciences) were implanted in 235 and 116 patients. Optimal prosthesis size was determined during TAVI by inflation of a balloon catheter at the aortic annulus. All patients had undergone CT-angiography of the heart or body trunk prior to TAVI. Using these datasets, the diameter of the long and short axis as well as the circumference and the area of the aortic annulus were measured. Multi-Class Receiver-Operator-Curve analyses were used to determine the predictive value of all variables and to define optimal cutoff-values.
Results
Differences between patients who underwent implantation of the small, medium or large prosthesis were significant for all except the large vs. medium CoreValve (all p’s<0.05). Furthermore, mean diameter, annulus area and circumference had equally high predictive value for prosthesis size for both manufacturers (multi-class AUC’s: 0.80, 0.88, 0.91, 0.88, 0.88, 0.89). Using the calculated optimal cutoff-values, prosthesis size is predicted correctly in 85% of cases.
Conclusion
CT-based aortic root measurements permit excellent prediction of the prosthesis size considered optimal during TAVI.
Citation: Schwarz F, Lange P, Zinsser D, Greif M, Boekstegers P, et al. (2014) CT-Angiography–Based Evaluation of the Aortic Annulus for Prosthesis Sizing in Transcatheter Aortic Valve Implantation (TAVI)–Predictive Value and Optimal Thresholds for Major Anatomic Parameters. PLoS ONE 9(8): e103481. doi:10.1371/journal.pone.0103481
Editor: Claudio Moretti, S. G. Battista Hospital, Italy
Received: December 23, 2013; Accepted: July 2, 2014; Published: August 1, 2014
Copyright: © 2014 Schwarz et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This work was supported by the DZHK (German Centre for Cardiovascular Research) and by the BMBF (German Ministry of Education and Research). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have read the journal’s policy and have the following conflicts: Professor Becker has received speaker honoraria from Siemens Healthcare. Professor Boekstegers is an employee of HELIOS Kliniken GmbH, yet his contribution to this study was made when he was an employee of the university hospital of the Ludwig-Maximilians-University of Munich. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.
