Accuracy of predicted orthogonal projection angles for valve deployment during transcatheter aortic valve replacement

Arie Steinvil; Gaby Weissman; Andrew W Ertel; Guy Weigold; Toby Rogers; Edward Koifman; Kyle D Buchanan; Christian Shults; Rebecca Torguson; Petros G Okubagzi; Lowell F Satler; Itsik Ben-Dor; Ron Waksman

doi:10.1016/j.jcct.2018.05.017

Accuracy of predicted orthogonal projection angles for valve deployment during transcatheter aortic valve replacement

J Cardiovasc Comput Tomogr. 2018 Sep-Oct;12(5):398-403. doi: 10.1016/j.jcct.2018.05.017. Epub 2018 May 26.

Affiliations

¹ Division of Interventional Cardiology and the MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, 20010, USA; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
² Division of Interventional Cardiology and the MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, 20010, USA.
³ Division of Interventional Cardiology and the MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, 20010, USA. Electronic address: ron.waksman@medstar.net.

PMID: 30064937
DOI: 10.1016/j.jcct.2018.05.017

Abstract

Background: Multi-detector computed tomography (MDCT) predicted orthogonal projection angles have been introduced to guide valve deployment during transcatheter aortic valve replacement (TAVR). Our aim was to investigate the accuracy of MDCT prediction methods versus actual angiographic deployment angles.

Methods: Retrospective analysis of 2 currently used MDCT methods: manual multiplanar reformations (MR) and the semiautomatic optimal angle graph (OAG). Paired analysis was used to compare the 2-dimensional distributions and means.

Results: We included 101 patients with a mean (±SD) age of 81 ± 9 years. The MR and OAG methods were used in 46 and 55 patients, respectively. A ≥5% change from the predicted MDCT range in left anterior oblique/right anterior oblique (LAO/RAO) and the cranial/caudal (CRA/CAU) angle occurred in 42% and 58% of patients, respectively. The mean predicted versus actual deployment angles were significantly different (CRA/CAU: -2.6 ± 11.5 vs. -7.6 ± 10.7, p < 0.001; RAO/LAO 8.1 ± 10.9 vs. 9.5 ± 10.6, p = 0.048; respectively). The MR method resulted in a more accurate CRA/CAU angle (CRA/CAU: -4.6 ± 11.1 vs. -6.5 ± 11.8, p = 0.139; RAO/LAO 7.4 ± 11.2 vs. 10.4 ± 11.2, p = 0.008; respectively), whereas the use of the OAG resulted in a more accurate RAO/LAO angle (CRA/CAU: -0.9 ± 10.8 vs. -9±11.2, p < 0.001; RAO/LAO 9.05 ± 10.6 vs. 8.5 ± 9.9, p = 0.458; respectively). For the entire cohort, the 2-dimensional distributions and means of the predicted versus the actual angles were significantly different from each other (p < 0.001). We repeated our analysis using both MDCT methods and demonstrated similar results with each method.

Conclusions: Currently used MDCT methods for TAVR implantation angles are significantly modified before actual valve deployment. Thus, further refinement of these prediction methods is required.

Keywords: Aortic stenosis; Cardiac catheterization; Computed tomography; Implantation angle; Transcatheter aortic valve replacement.

Publication types

Comparative Study

MeSH terms

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*
Computed Tomography Angiography / methods*
Coronary Angiography / methods*
Female
Heart Valve Prosthesis
Humans
Male
Multidetector Computed Tomography / methods*
Predictive Value of Tests
Radiographic Image Interpretation, Computer-Assisted / methods*
Reproducibility of Results
Retrospective Studies
Transcatheter Aortic Valve Replacement* / instrumentation