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Observational Study
. 2020 Apr 6;7(1):e001233.
doi: 10.1136/openhrt-2019-001233. eCollection 2020.

CT imaging prior to transcatheter aortic valve implantation in the UK

Iwan Harries  1 , Jonathan R Weir-McCall  2 , Michelle C Williams  3 , James Shambrook  4 , Giles Roditi  5 , Russel Bull  6 , Gareth J Morgan-Hughes  7 , Edward D Nicol  8 , Alastair J Moss  9
Affiliations
Observational Study

CT imaging prior to transcatheter aortic valve implantation in the UK

Iwan Harries et al. Open Heart. .

Abstract

Objective: This cross-sectional observational study sought to describe variations in CT in the context of transcatheter aortic valve implantation (CT-TAVI) as currently performed in the UK.

Methods: 408 members of the British Society of Cardiovascular Imaging were invited to complete a 27-item online CT-TAVI survey.

Results: 47 responses (12% response rate) were received from 40 cardiac centres, 23 (58%) of which performed TAVI on-site (TAVI centres). Only six respondents (13%) performed high-volume activity (>200 scans per year) compared with 13 (28%) performing moderate (100-200 scans per year) and 27 (59%) performing low (0-99 scans per year) volume activity. Acquisition protocols varied (41% retrospective, 12% prospective with wide padding, 47% prospective with narrow padding), as did the phase of reporting (45% systolic, 37% diastolic, 11% both, 6% unreported). Median dose length product was 675 mGy.cm (IQR 477-954 mGy.cm). Compared with non-TAVI centres, TAVI centres were more likely to report minimum iliofemoral luminal diameter (n=25, 96% vs n=7, 58%, p=0.003) and optimal tube angulation for intervention (n=12, 46% vs n=1, 8%, p=0.02).

Conclusions: This national survey formally describes current CT-TAVI practice in the UK. High-volume activity was only present at one in seven cardiac CT centres. There is wide variation in scan acquisition, scan reporting and radiation dose exposure in cardiac CT centres.

Keywords: CT scanning; aortic valve disease; percutaneous valve therapy.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Geographical distribution of survey respondents. Cardiac CT centres from England, Scotland, Wales and Northern Ireland provided survey data (A). Sixty-five per cent of respondents worked in centres that provided a transcatheter aortic valve implantation (TAVI) programme (B). Annualised activity varied across centres with non-TAVI centres performing <100 scans per annum (C).
Figure 2
Figure 2
CT-TAVI scan acquisition protocols. Image acquisition protocols according to centre type (A). Phase of measurement reporting according to centre type (B). TAVI, transcatheter aortic valve implantation.
Figure 3
Figure 3
Dissemination of findings to Heart Team. Heart Team multidisciplinary discussions were present at 76% of centres overall (A). When Heart Team discussions were in place, a cardiac imaging specialist was ‘always present’ at 57% of meetings (B). There was a significant difference in the provision of Heart Team meetings at TAVI and non-TAVI centres (96%, n=24/25 vs 33%, n=4/12, p<0.001) (C). TAVI, transcatheter aortic valve implantation.
See this image and copyright information in PMC

References

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