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MDCT planning of trans catheter aortic valve implantation (TAVI): determination of optimal c-arm angulation

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Abstract

A fluoroscopic view perpendicular to the aortic valve annulus is required during transcatheter aortic valve implantation (TAVI) for obtaining an optimal deployment of the bioprosthesis. By predicting c-arm angulation, pre-procedural MDCT could decrease the number of aortograms, shorten the time of the procedure and reduce the amount of intra-arterial contrast agent. The aim of our study was to assess the accuracy of MDCT in predicting c-arm angulation at the cath. lab. In this single center study, we investigated MDCT prediction of c-arm angulation in patients having undergone a TAVI procedure using SAPIEN 3® (Edwards Lifesciences, USA). Prior to the procedure, an experienced radiologist had reported the angulation using dedicated software (CTreport). After the procedure, a blinded experienced radiologist retrospectively measured the angles using the same method (CTstudy). Interobserver variability was drawn from the comparison between CTreport and CTstudy. Then, the mean angular difference between the predicted MDCT angles (CTstudy) was compared to the working view recorded at the cath. lab. Seventy-nine patients (M/F = 0.65; mean age: 85.2 years ± 5.3) were included. Interobserver variability was 5.9 ± 6.1°. The mean absolute difference between MDCT and fluoroscopy was 8.8 ± 7.1°. The present study showed that MDCT could predict the coplanar fluoroscopic angles prior to TAVI using a balloon-expandable bioprosthesis Sapien 3® placed via a transfemoral approach with a mean angular difference of 8.8 ± 7.1°. Reproducibility was considered good as the mean difference between two independent measures was 5.9 ± 6.1°.

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Abbreviations

MDCT:

Multi detector computed tomography

TAVI:

Trans catheter aortic valve implantation

BMI:

Body mass index

LAO:

Left anterior oblique orientation

RAO:

Right anterior oblique orientation

CRA:

Cranial oblique orientation

CAU:

Caudal oblique orientation

AP view:

Anteroposterior view

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Authors and Affiliations

  1. Centre Hospitalier Universitaire de Rouen, Rouen, France

    Benjamin Mehier, Benjamin Dubourg, Hélène Eltchaninoff, Eric Durand, Christophe Tron, Alain Cribier, Paul Michelin & Jean-Nicolas Dacher

  2. Normandie University, UNIROUEN, INSERM U1096, Rouen, France

    Benjamin Dubourg, Hélène Eltchaninoff, Eric Durand, Alain Cribier & Jean-Nicolas Dacher

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  1. Benjamin Mehier
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  2. Benjamin Dubourg
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  3. Hélène Eltchaninoff
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  5. Christophe Tron
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  8. Jean-Nicolas Dacher
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Correspondence to Benjamin Mehier.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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The institutional review board approved this retrospective study and informed consent was waived.

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Mehier, B., Dubourg, B., Eltchaninoff, H. et al. MDCT planning of trans catheter aortic valve implantation (TAVI): determination of optimal c-arm angulation. Int J Cardiovasc Imaging 36, 1551–1557 (2020). https://doi.org/10.1007/s10554-020-01846-0

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  • DOI: https://doi.org/10.1007/s10554-020-01846-0

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