Keywords
Angiotac de corazón (MDCT)
Ecocardiografía transesofágica (TEE)
Angiografía
Estenosis aórtica severa Transcatheter Aortic Valve Implantation (TAVI)
Multidetector Computed Tomography
Angiography
Echocardiography, Transesophagea
Aortic Valve Stenosis
How to Cite
Abstract
Introduction: TAVI has increasingly become a viable treatment for patients with severe aortic stenosis (AS) at excessive surgical risk. Severe aortic stenosis is a condition that affects the general population, especially elderly individuals. Proper selection of patients is critical and requires imaging studies before percutaneous implant. Objective: with growing experience, our group has strengthen its pre-procedure assessment of anatomical valve annulus parameters, discrepancies have arisen in the measurements between the different imaging modalities used. We sought to validate and demonstrate the degree of correlation between these modalities and determine possible factors that might influence the results. Methods: between March 2008 and February 2012, a total of 81 consecutive patients underwent TAVI with the Medtronic-CoreValve System (MCS). All endpoints were defined in accordance with the Valve Academic Research Consortium recommendations. Fifty-eight patients had a MDCT done prior to implantation, but 53 patients (65%). The mean annulus diameter was calculated and compared between echo, MDCT (also included major and minor annulus diameters, and Agatston valve scoring) and angiographic measurements, and with the final size of the implanted valve. To address the learning curve issue, the group was divided: (a) the first early 40 TAVI cases (first 23 patients with MDCT performed), and (b) the second latest 41 patients (late 30 patients with MDCT). Results: aortic annulus diameter correlations were: low for TEE vs. MDCT (r=0,11; p<0,47); moderate for TEE vs angiography (r=0,337; p<0,018); moderate for MDCT vs. Angiography (r=0,365; p<0,009). No significant changes regarding the early or late subgroups by echo, but MDCT and angiography significantly increased from r=0,22 in the early group to r=0,70 (p<0,001) in the late group. Correlations with the valve size finally implanted (26 mms, 29 mms, or 31 mms) were: MDCT general (r=0,67; p<0,001),with first subgroup (r=0,65; p<0,001), and second subgroup (r=0.78; p<0,001); angiography general (r=0,50; p<0,005), with first subgroup (r=0,39; p<0,005), and second subgroup (r=0,60; p<0,004); and finally for TEE general (r=0,39; p<0,006), with first subgroup (r=0,41; p<0,03), and second subgroup (r=0,33; p<0,14). The Agatston median score was: for early subgroup 2627 U, for late subgroup 3058 U (p=0,108). The annulus difference between the major and minor diameters 4.5 cms in the early subgroup and 3.1 cms in the late subgroup (p=0,047). Conclusions: with growing experience in TAVI procedures, the working groups are demonstrating that MDCT should be preferred over other imaging modalities for valve sizing. This study clearly shows that there is a learning curve that strengthens MDCT´s reliability, although some geometric shape deformation of the aortic annulus could account for a less early correlation. Definitely, the calcium burden and its asymmetrical deformation should be no obstacle for an accurate assessment of the aortic valve annulus by MDCT.
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