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EFFECTIVE AORTIC ANNULUS SIZING BY 3D-CT IS SUPERIOR TO 2D-CT FOR REDUCTION OF PARAVALVULAR LEAKS AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION
Nikolaos Bonaros, Fabian Plank, Guy Friedrich, Thomas Bartel, Silvana Mueller, Anneliese Heinz, Thomas Schachner, Ludwig Mueller, Michael Grimm, Gudrun Feuchtner.
Innsbruck Medical University, Innsbruck, Austria.

OBJECTIVE: The ideal method to define aortic annulus dimensions before transcatheter valve implantation (TAVI) remains a matter of discussion. The aim of our study was to evaluate annulus sizing by 3-D computed tomography for prediction of paravalvular leaks (PL) after TAVI.
METHODS: Sixty nine patients (mean age 83y) with severe aortic stenosis underwent TAVI, transesophageal echocardiography (TEE) and CT and were stratified to two groups according to the presence of PL>0. Two- and three-D annulus diameter and area were measured. Conventional TEE and CT measured AP-diameter were used for valve selection. “Undersizing” was defined as the difference between CT-nominal valve size; “annulus eccentricity” as AP/ML-ratio. PL were detected by echocardiography.
RESULTS: Incidence of PL was: 0:21(30%), I:32(46%), I-II:8(12%), II:5(7%), II-III:3(4%), and >III:0. Preoperative TEE measured smaller mean annulus diameters than CT (-2,58mm, p<0.01). Undersizing occurred in 51% of the valves (no-PL:6/21(29%) and PL:29/48 (60%)). PL-patients had a higher undersizing grade (1.4 vs 0.4mm, p=0.01). The difference of CT-measured annulus area - nominal valve area was higher in PL-patients (1.12cm² vs. 0.5cm², p=0.04). Annulus eccentricity index was also higher in the PL-group (0.83vs.0.79, p=0.01). Application of 3D instead of 2D annulus measurement led to an increase in sensitivity and specificity of 9% and 10% respectively.
CONCLUSIONS:
Valve undersizing and higher annulus eccentricity are associated with paravalvular leaks after TAVI. 3D annulus sizing by CT may be more accurate than the commonly-used 2D method.


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