Variables affecting the accuracy of MDCT in prediction of the proper prosthesis deployment projection for transcatheter aortic valve implantation

Objective: We evaluated multidetector computed tomography (MDCT) accuracy for the prediction of the optimal prosthetic aortic valve deployment angle in trans-catheter aortic valve implantation (TAVI) with the different variables.Methods: Sixty-six patients underwent contrast-enhanced MDCT before TAVI. From the three-dimensional aortic root reconstructions, we get the appropriate perpendicular aortic valve projection at which the bases of the aortic valve cusps were on a straight line. The predicted angles by MDCT were compared to the perpendicular fluoroscopic angles of the prosthetic valve. The degree of MDCT accuracy was defined as accurate, suitable or inaccurate according to the difference between the predicted angles and the perpendicular prosthetic valve projections. The degree of aortic cusp calcification, annular ellipticity, the type of aortic valve (to be tricuspid or bicuspid), were compared in patients with accurate, suitable and inaccurate prediction. The radiation exposure and volume of the used contrast agent were also considered in the comparison.Results: MDCT prediction was accurate in 84.8% of cases, suitable in 9.1% and inaccurate in 6.1% of cases. There was a significant association between MDCT accuracy and the valve type with higher rates of accurate prediction with tricuspid aortic valves than bicuspid valves (93.1% versus 25%, respectively). The mean number of aortograms and the volume of contrast agent used for TAVI procedure were significantly less in patients with accurate CT prediction (p < 0.001).Conclusion: MDCT allows accurate prediction of the proper deployment angle for TAVI. Bicuspid aortic valve is significantly associated with fewer rates of accurate prediction