Relationship of annular sizing using multidetector computed tomographic imaging and clinical outcomes after self-expanding corevalve transcatheter aortic valve replacement

Jeffrey J. Popma, Thomas G. Gleason, Steven J. Yakubov, J. Kevin Harrison, John K. Forrest, Brijeshwar Maini, Carlos E. Ruiz, Duane S. Pinto, Marco Costa, Jon Resar, John Conte, Juan Crestanello, Yanping Chang, Jae Kuen Oh, Michael J. Reardon, David H. Adams

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background - Multidetector computed tomography is useful for determining the appropriate transcatheter heart valve (THV) size in patients with severe aortic stenosis who are suboptimal surgical candidates. The relationship between adherence to the recommended CoreValve sizing algorithm and clinical outcomes is not known. Methods and Results - We evaluated 1023 patients with severe aortic stenosis deemed high or extreme risk for surgery treated with the CoreValve THV. All patients underwent preprocedural multidetector computed tomography, and the scans were reviewed at a central analysis center using standardized software. Compliance to a recommended sizing algorithm was used to identify patients with below-range, in-range, and above-range THV sizing. A device annular sizing ratio (DAR) was also calculated based on the native annulus perimeter and perimeter of the selected THV. Clinical end points included the presence of paravalvular aortic regurgitation evaluated by an independent echocardiographic laboratory. Adherence to the sizing algorithm was highest with a 31-mm THV (92.6%) and lowest with the 23-mm THV (38.5%). Below-range sizing was associated with a higher rate of moderate or severe paravalvular aortic regurgitation (15.3%) than in-range (6.5%) or above-range (10.0%; P<0.001) sizing. Higher DARs were associated with lower rates of moderate or severe paravalvular aortic regurgitation: DAR ≤10%, 17.6%; DAR 10% to 15%, 9.9%; DAR 15% to 20%, 6.3%; and DAR >20%, 4.9%; P<0.001. There was no increase in clinical events associated with higher DARs. Conclusions - Adherence to a sizing algorithm guided by multidetector computed tomography resulted in lower rates of paravalvular aortic regurgitation after self-expanding transcatheter valve replacement without an increase in complications.

Original languageEnglish (US)
JournalCirculation: Cardiovascular Interventions
Volume9
Issue number7
DOIs
StatePublished - Jul 1 2016

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Heart Valves
Aortic Valve Insufficiency
Multidetector Computed Tomography
Aortic Valve Stenosis
Transcatheter Aortic Valve Replacement
Software
Equipment and Supplies

Keywords

  • annular geometry
  • aortic regurgitation
  • aortic stenosis
  • multidetector CT imaging
  • transcatheter aortic valve
  • valvular heart disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Relationship of annular sizing using multidetector computed tomographic imaging and clinical outcomes after self-expanding corevalve transcatheter aortic valve replacement. / Popma, Jeffrey J.; Gleason, Thomas G.; Yakubov, Steven J.; Harrison, J. Kevin; Forrest, John K.; Maini, Brijeshwar; Ruiz, Carlos E.; Pinto, Duane S.; Costa, Marco; Resar, Jon; Conte, John; Crestanello, Juan; Chang, Yanping; Oh, Jae Kuen; Reardon, Michael J.; Adams, David H.

In: Circulation: Cardiovascular Interventions, Vol. 9, No. 7, 01.07.2016.

Research output: Contribution to journalArticle

Popma, JJ, Gleason, TG, Yakubov, SJ, Harrison, JK, Forrest, JK, Maini, B, Ruiz, CE, Pinto, DS, Costa, M, Resar, J, Conte, J, Crestanello, J, Chang, Y, Oh, JK, Reardon, MJ & Adams, DH 2016, 'Relationship of annular sizing using multidetector computed tomographic imaging and clinical outcomes after self-expanding corevalve transcatheter aortic valve replacement', Circulation: Cardiovascular Interventions, vol. 9, no. 7. https://doi.org/10.1161/CIRCINTERVENTIONS.115.003282
Popma, Jeffrey J. ; Gleason, Thomas G. ; Yakubov, Steven J. ; Harrison, J. Kevin ; Forrest, John K. ; Maini, Brijeshwar ; Ruiz, Carlos E. ; Pinto, Duane S. ; Costa, Marco ; Resar, Jon ; Conte, John ; Crestanello, Juan ; Chang, Yanping ; Oh, Jae Kuen ; Reardon, Michael J. ; Adams, David H. / Relationship of annular sizing using multidetector computed tomographic imaging and clinical outcomes after self-expanding corevalve transcatheter aortic valve replacement. In: Circulation: Cardiovascular Interventions. 2016 ; Vol. 9, No. 7.
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AU - Popma, Jeffrey J.

AU - Gleason, Thomas G.

AU - Yakubov, Steven J.

AU - Harrison, J. Kevin

AU - Forrest, John K.

AU - Maini, Brijeshwar

AU - Ruiz, Carlos E.

AU - Pinto, Duane S.

AU - Costa, Marco

AU - Resar, Jon

AU - Conte, John

AU - Crestanello, Juan

AU - Chang, Yanping

AU - Oh, Jae Kuen

AU - Reardon, Michael J.

AU - Adams, David H.

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N2 - Background - Multidetector computed tomography is useful for determining the appropriate transcatheter heart valve (THV) size in patients with severe aortic stenosis who are suboptimal surgical candidates. The relationship between adherence to the recommended CoreValve sizing algorithm and clinical outcomes is not known. Methods and Results - We evaluated 1023 patients with severe aortic stenosis deemed high or extreme risk for surgery treated with the CoreValve THV. All patients underwent preprocedural multidetector computed tomography, and the scans were reviewed at a central analysis center using standardized software. Compliance to a recommended sizing algorithm was used to identify patients with below-range, in-range, and above-range THV sizing. A device annular sizing ratio (DAR) was also calculated based on the native annulus perimeter and perimeter of the selected THV. Clinical end points included the presence of paravalvular aortic regurgitation evaluated by an independent echocardiographic laboratory. Adherence to the sizing algorithm was highest with a 31-mm THV (92.6%) and lowest with the 23-mm THV (38.5%). Below-range sizing was associated with a higher rate of moderate or severe paravalvular aortic regurgitation (15.3%) than in-range (6.5%) or above-range (10.0%; P<0.001) sizing. Higher DARs were associated with lower rates of moderate or severe paravalvular aortic regurgitation: DAR ≤10%, 17.6%; DAR 10% to 15%, 9.9%; DAR 15% to 20%, 6.3%; and DAR >20%, 4.9%; P<0.001. There was no increase in clinical events associated with higher DARs. Conclusions - Adherence to a sizing algorithm guided by multidetector computed tomography resulted in lower rates of paravalvular aortic regurgitation after self-expanding transcatheter valve replacement without an increase in complications.

AB - Background - Multidetector computed tomography is useful for determining the appropriate transcatheter heart valve (THV) size in patients with severe aortic stenosis who are suboptimal surgical candidates. The relationship between adherence to the recommended CoreValve sizing algorithm and clinical outcomes is not known. Methods and Results - We evaluated 1023 patients with severe aortic stenosis deemed high or extreme risk for surgery treated with the CoreValve THV. All patients underwent preprocedural multidetector computed tomography, and the scans were reviewed at a central analysis center using standardized software. Compliance to a recommended sizing algorithm was used to identify patients with below-range, in-range, and above-range THV sizing. A device annular sizing ratio (DAR) was also calculated based on the native annulus perimeter and perimeter of the selected THV. Clinical end points included the presence of paravalvular aortic regurgitation evaluated by an independent echocardiographic laboratory. Adherence to the sizing algorithm was highest with a 31-mm THV (92.6%) and lowest with the 23-mm THV (38.5%). Below-range sizing was associated with a higher rate of moderate or severe paravalvular aortic regurgitation (15.3%) than in-range (6.5%) or above-range (10.0%; P<0.001) sizing. Higher DARs were associated with lower rates of moderate or severe paravalvular aortic regurgitation: DAR ≤10%, 17.6%; DAR 10% to 15%, 9.9%; DAR 15% to 20%, 6.3%; and DAR >20%, 4.9%; P<0.001. There was no increase in clinical events associated with higher DARs. Conclusions - Adherence to a sizing algorithm guided by multidetector computed tomography resulted in lower rates of paravalvular aortic regurgitation after self-expanding transcatheter valve replacement without an increase in complications.

KW - annular geometry

KW - aortic regurgitation

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KW - multidetector CT imaging

KW - transcatheter aortic valve

KW - valvular heart disease

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