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Impact of Electrocardiogram‐ G ated Multi‐ S lice Computed Tomography– B ased Aortic Annular Measurement in the Evaluation of Paravalvular Leakage Following Transcatheter Aortic Valve Replacement: The Efficacy of the Over S ized Aorti C Annular Ratio ( OSACA Ratio) in TAVR
Author(s) -
Maeda Koichi,
Kuratani Toru,
Torikai Kei,
Shimamura Kazuo,
Mizote Isamu,
Ichibori Yasuhiro,
Takeda Yasuharu,
Daimon Takashi,
Nakatani Satoshi,
Nanto Shinsuke,
Sawa Yoshiki
Publication year - 2013
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.12143
Subject(s) - medicine , cardiology , aortic valve , computed tomography , leakage (economics) , radiology , economics , macroeconomics
Background Even mild paravalvular leakage (PVL) after transcatheter aortic valve replacement (TAVR) is associated with increased late mortality. Electrocardiogram‐gated multi‐slice computed tomography (MSCT) enables detailed aortic annulus assessment. We describe the impact of MSCT for PVL following TAVR. Methods Congruence between the prosthesis and annulus diameters affects PVL; therefore, we calculated the OverSized AortiC Annular ratio (OSACA ratio) and OSACA (transesophageal echocardiography, TEE) ratio as prosthesis diameter / annulus diameter on MSCT or TEE, respectively, and compared their relationship with PVL ≤ trace following TAVR. Results Of 36 consecutive patients undergoing TAVR (Group A), the occurrence of PVL ≤ trace (33.3%) was significantly related to the OSACA ratio (p = 0.00020). In receiver‐operating characteristics analysis, the cutoff value of 1.03 for the OSACA ratio had the highest sum of sensitivity (75.0%) and specificity (91.7%; AUC = 0.87) with significantly higher discriminatory performance for PVL as compared to the OSACA (TEE) ratio (AUC = 0.69, p = 0.028). In nine consecutive patients (Group B) undergoing TAVR based on guidelines formulated from our experience with Group A, PVL ≤ trace was significantly more frequent (88.9%) than that in Group A (p = 0.0060). Conclusions The OSACA ratio has a significantly higher discriminatory performance for PVL ≤ trace than the OSACA (TEE) ratio, and aortic annular measurement from MSCT is more accurate than that from TEE. doi: 10.1111/jocs.12143 (J Card Surg 2013;28:373–379)