Radiological exposure of patients undergoing transcatheter aortic valve implantation in contemporary practice

J Cardiovasc Med (Hagerstown). 2018 Oct;19(10):579-585. doi: 10.2459/JCM.0000000000000692.

Abstract

Background: Radiological exposure associated with transcatheter aortic valve implantation (TAVI) is unknown and might impact on broadening indications to lower risk patients. Radiological exposure of TAVI patients and its predictors are herein reported.

Methods: Radiological exposure derived from exams/procedures performed within 30 days preceding/following TAVI were acquired and converted into effective-dose. Total effective-dose was defined as the sum of each single dose derived from diagnostic/therapeutic sources. Univariable and multivariable analyses were performed to recognize correlates of exposure.

Results: Seventy-five patients aged 82.6 ± 6.0 years with a median Euroscore II 3.6 [IQR 1.93-6.65] were analysed. Median total effective-dose was 41.39 mSv [IQR 27.93-60.88], with TAVI accounting for 47% of it. Age (coefficient -0.031, 95% CI -0.060 to -0.002; P = 0.031) and previous history of cerebrovascular accidents (CVA; coefficient -0.545; 95% CI -1.039 to -0.010; P = 0.046) resulted as inversely correlated to total effective-dose (log-transformed), whereas left ventricular ejection fraction (LVEF) less than 50% (coefficient 0.430, 95% CI 0.031-0.828; P = 0.035) was directly associated.

Conclusion: Multiple radiological sources are responsible for the observed exposure, with TAVI being the prominent source. Age is inversely related to the radiological exposure.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Aortic Valve / diagnostic imaging*
  • Aortic Valve / physiopathology
  • Aortic Valve / surgery*
  • Aortic Valve Stenosis / diagnostic imaging*
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / surgery*
  • Coronary Angiography* / adverse effects
  • Female
  • Humans
  • Male
  • Multidetector Computed Tomography* / adverse effects
  • Radiation Dosage*
  • Radiation Exposure* / adverse effects
  • Radiography, Interventional* / adverse effects
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Transcatheter Aortic Valve Replacement* / adverse effects
  • Treatment Outcome