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

by Steinvil, Arie; Weissman, Gaby; Ertel, Andrew; Weigold, William Guy; Rogers, Toby; Koifman, Edward; Buchanan, Kyle; Shults, Christian; Torguson, Rebecca; Okubagzi, Petros; Satler, Lowell F; Ben-Dor, Itsik; Waksman, Ron.
Citation: Journal of cardiovascular computed tomography. 12(5):398-403, 2018 Sep - Oct..Journal: Journal of cardiovascular computed tomography.Published: 2018ISSN: 1876-861X.Full author list: Steinvil A; Weissman G; Ertel AW; Weigold G; Rogers T; Koifman E; Buchanan KD; Shults C; Torguson R; Okubagzi PG; Satler LF; Ben-Dor I; Waksman R.UI/PMID: 30064937.Subject(s): Aged | Aged, 80 and over | *Aortic Valve/dg [Diagnostic Imaging] | Aortic Valve/pp [Physiopathology] | *Aortic Valve/su [Surgery] | *Aortic Valve Stenosis/dg [Diagnostic Imaging] | Aortic Valve Stenosis/pp [Physiopathology] | *Aortic Valve Stenosis/su [Surgery] | *Computed Tomography Angiography/mt [Methods] | *Coronary Angiography/mt [Methods] | Female | Heart Valve Prosthesis | Humans | Male | *Multidetector Computed Tomography/mt [Methods] | Predictive Value of Tests | *Radiographic Image Interpretation, Computer-Assisted/mt [Methods] | Reproducibility of Results | Retrospective Studies | Transcatheter Aortic Valve Replacement/is [Instrumentation] | *Transcatheter Aortic Valve ReplacementInstitution(s): MedStar Washington Hospital CenterDepartment(s): Internal Medicine | MedStar Heart & Vascular InstitutActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1016/j.jcct.2018.05.017 (Click here) Abbreviated citation: J Cardiovasc Comput Tomogr. 12(5):398-403, 2018 Sep - Oct.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.Abstract: 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.Abstract: 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.Abstract: 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.Abstract: Copyright (c) 2018 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

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