Prediction of fluoroscopic angulations for transcatheter aortic valve implantation by CT angiography: influence on procedural parameters

Abstract Aims Repeated angiograms to achieve an exactly orthogonal visualization of the aortic valve plane can substantially contribute to the total contrast amount required for transcatheter aortic valve implantation (TAVI). We investigated whether pre-procedural identification of an optimal fluoro...

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Bibliographic Details
Published in:European heart journal cardiovascular imaging 2017-05, Vol.18 (8), p.906-914
Main Authors: Hell, Michaela M., Biburger, Lukas, Marwan, Mohamed, Schuhbaeck, Annika, Achenbach, Stephan, Lell, Michael, Uder, Michael, Arnold, Martin
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Aortic Valve Stenosis - diagnostic imaging
Aortic Valve Stenosis - surgery
Cohort Studies
Computed Tomography Angiography - methods
Female
Fluoroscopy - methods
Humans
Male
Postoperative Complications - mortality
Postoperative Complications - physiopathology
Predictive Value of Tests
Preoperative Care - methods
Prognosis
Retrospective Studies
Risk Assessment
Severity of Illness Index
Statistics, Nonparametric
Survival Rate
Transcatheter Aortic Valve Replacement - methods
Treatment Outcome
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Summary:Abstract Aims Repeated angiograms to achieve an exactly orthogonal visualization of the aortic valve plane can substantially contribute to the total contrast amount required for transcatheter aortic valve implantation (TAVI). We investigated whether pre-procedural identification of an optimal fluoroscopic projection by cardiac computed tomography (CT) can significantly reduce the amount of a procedure-related contrast agent compared with angiographic determination of suitable angulations. Methods and results Eighty consecutive patients (81 ± 5 years, 55% male) with symptomatic severe aortic valve stenosis and normal renal function who underwent cardiac CT prior to TAVI were prospectively randomized. In 40 patients, a CT-predicted suitable angulation was used for the first aortic angiogram (CT cohort); in the other 40 patients, the first aortogram was acquired at LAO 10°/cranial 10 (angiography cohort). Additional aortograms were performed if no satisfactory view of the aortic valve plane was obtained. The number of aortograms needed to achieve a satisfactory fluoroscopic projection (1.2 ± 0.6 vs. 3.2 ± 1.7; P < 0.001) and the total amount of contrast agent per TAVI procedure were significantly lower in the CT cohort (95 ± 21 vs. 125 ± 36 mL; P < 0.001). Incidence of acute kidney injury was not significantly different. There was no significant difference regarding radiation dose, time of procedure, degree of post-procedural aortic regurgitation, complications and 30-day mortality between the cohorts. Conclusion Pre-procedural identification of a suitable fluoroscopic projection by cardiac CT significantly reduces a procedural contrast agent volume required for TAVI.
ISSN:2047-2404
2047-2412
DOI:10.1093/ehjci/jew144