Article Text
Abstract
Background The gold-standard approach to prosthesis sizing before transcatheter aortic valve implantation (TAVI) is multislice computed tomography (MSCT). We aimed to investigate whether conventional aortic root angiography (CA) alone can reliably facilitate valve selection and to describe its inter-reader variability.
Methods Five TAVI specialists (3 interventional cardiologists and 2 cardiac surgeons) independently reviewed preprocedural CAs for 50 patients implanted with the Edwards SAPIEN 3 valve.
Results The prosthesis size selected based on visual CA appraisal matched that based on MSCT in 60% of cases (range: 50%–68%), with undersizing in 11% (4%–33%) and oversizing in 29% (10%–46%; p=0.187 for equality of the proportions test). Agreement between CA-based and MSCT-based valve selection was moderate (K=0.41; Kw=0.61). Reassessment of choice following awareness of the annulus long-axis diameter did not significantly improve this agreement (0.40 and 0.63, respectively), though more undersizing (14%) and less oversizing (25%) occurred. Correct valve selection was more common in interventional cardiologists than cardiac surgeons (66% vs 53%; p=0.0391), who made more oversizing errors.
Conclusions There is a modest agreement between CA-based and MSCT-based SAPIEN 3 selection. Although the former should not be performed routinely, it may be informative in settings where MSCT and transoesophageal echocardiography are unavailable.
- surgery-valve
- prosthetic heart valves
- minimally invasive
- imaging and diagnostics
- aortic valve disease
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Footnotes
Contributors LG and CT: contributed to conception and design of this work. LG, SK, FO, TM-H, WvS and CT: collected the data. BU: designed the statistical approach, analysis and interpretation. PB: outlined the first version of the manuscript, which all other authors revised for important intellectual content. All authors approved the final version of the manuscript to be submitted.
Funding Edwards Lifesciences provided funding for the preparation of this manuscript.
Disclaimer The funder had no role in the design of the study, the data collection, analysis, interpretation of data and the writing / revision of the manuscript.
Competing interests SK is a consultant for Jena Valve and Edwards Lifesciences. CT is a consultant for Boston Scientific and receives research support from Edwards Lifesciences and Boston Scientific. PB is a consultant for Abbott, Boston Scientific and Edwards Lifesciences.
Patient consent for publication Not required.
Ethics approval The research was approved by the Augsburg University ethics committee and conducted in line with the declaration of Helsinki. Written informed consent was unnecessary as existing anonymised data were utilised.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon request.