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. 2021 Jan;110(1):93-101.
doi: 10.1007/s00392-020-01654-5. Epub 2020 May 12.

Predictors for low TAVI-prosthesis position assessed by fusion imaging of pre- and post-procedural CT angiography

Philipp Breitbart  1 , Gregor Pache  2 , Jan Minners  3 , Manuel Hein  3 , Holger Schröfel  4 , Franz-Josef Neumann  3 , Philipp Ruile  3
Affiliations

Predictors for low TAVI-prosthesis position assessed by fusion imaging of pre- and post-procedural CT angiography

Philipp Breitbart et al. Clin Res Cardiol. 2021 Jan.

Abstract

Background: Low prosthesis position after transcatheter aortic valve implantation (TAVI) is associated with higher rates of new onset conduction disturbances and permanent pacemaker implantations. Purpose of this study was to investigate possible predictors of a low prosthesis position of the SAPIEN 3 (Edwards Lifesciences, Irvine, California, USA) valve type using fusion imaging of pre- and post-procedural computed tomography angiography (CTA).

Methods: CTA fusion imaging was performed in 120 TAVI-patients with 3D-reconstruction of the transcatheter heart valve (THV) position within the device landing zone. A low implantation position was defined according to the manufacturer's recommendations as > 30% of the prosthesis below the native annulus plane.

Results: A low THV position was found in 17 patients (14%). Patients with low THV position had less calcification of the annulus region and a smaller annulus size compared to patients with a normal or high THV position (P = 0.003 and 0.041, respectively). The only independent predictor of a low THV position in multivariate logistic regression analysis was the extent of calcification of the cusp region (odds ratio [CI] 0.842 [0.727-0.976], P = 0.022).

Conclusions: Fusion imaging of pre-and post-procedural CTA identified reduced calcification of the cusp region as an independent predictor of a low THV position of the SAPIEN 3. This should be considered when planning the TAVI procedure. Correlation of cusp region calcification and prosthesis position after TAVI.

Keywords: Computed tomography angiography; Device landing zone calcification; Fusion imaging; Post-TAVI CTA; TAVI; THV positioning.

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Figures

Fig. 1
Fig. 1
Calcification assessment of the device landing zone. Pre-TAVI contrast-enhanced CTA sagittal oblique and axial reconstruction delineating the two different heights of the device landing zone (a red line delineating the annulus plane) and the division of the aortic valve into three cups for the semiquantitative calcification scoring (b)
Fig. 2
Fig. 2
Semiquantitatitve calcification assessment of the device landing zone. Pre-TAVI contrast-enhanced CTA axial and sagittal oblique reconstruction for visual calcification assessment with examples for mild (a, b), moderate (c, d) or severe (e, f) calcification of the cups regions and a severe calcification of the region below the annulus (g, h)
Fig. 3
Fig. 3
Assessment of post-implantation parallaxes. Post-implantation fluoroscopy image for measurement of the projection-related difference between the anterior and posterior upper prosthesis edge (b) in relation to the prosthesis diameter (d) to determine possible parallaxes of the THV as an expression of the projection accuracy
Fig. 4
Fig. 4
Evaluation of the prosthesis position after TAVI. Fusion images of pre- and post-TAVI CTA of a 80-year-old woman with a low prosthesis position after TAVI (a) and a 82-year-old man with a normal prosthesis position, according to the manufacturer’s recommendations (b). The numbers within the arrows delineating the mean THV length (in mm) above and below the native annulus plane (= black line)
See this image and copyright information in PMC

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