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

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Citation: Journal of cardiovascular computed tomography. 12(5):398-403, 2018 Sep - Oct.PMID: 30064937Institution: MedStar Washington Hospital CenterDepartment: Internal Medicine | MedStar Heart & Vascular InstitutForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Aortic Valve Stenosis/dg [Diagnostic Imaging] | *Aortic Valve Stenosis/su [Surgery] | *Aortic Valve/dg [Diagnostic Imaging] | *Aortic Valve/su [Surgery] | *Computed Tomography Angiography/mt [Methods] | *Coronary Angiography/mt [Methods] | *Multidetector Computed Tomography/mt [Methods] | *Radiographic Image Interpretation, Computer-Assisted/mt [Methods] | *Transcatheter Aortic Valve Replacement | Aged | Aged, 80 and over | Aortic Valve Stenosis/pp [Physiopathology] | Aortic Valve/pp [Physiopathology] | Female | Heart Valve Prosthesis | Humans | Male | Predictive Value of Tests | Reproducibility of Results | Retrospective Studies | Transcatheter Aortic Valve Replacement/is [Instrumentation]Year: 2018ISSN:
  • 1876-861X
Name of journal: Journal of cardiovascular computed tomographyAbstract: 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.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.Copyright (c) 2018 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.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.All authors: Ben-Dor I, Buchanan KD, Ertel AW, Koifman E, Okubagzi PG, Rogers T, Satler LF, Shults C, Steinvil A, Torguson R, Waksman R, Weigold G, Weissman GFiscal year: FY2019Fiscal year of original publication: FY2018Digital Object Identifier: Date added to catalog: 2018-08-02
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Journal Article MedStar Authors Catalog Article 30064937 Available 30064937

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.

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.

Copyright (c) 2018 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

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.

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