Balloon Versus Computed Tomography Sizing of the Aortic Annulus for Transcatheter Aortic Valve Replacement and the Impact of Left Ventricular Outflow Tract Calcification and Morphology on Sizing

Jose F. Condado, Stamatios Lerakis, James Stewart, Hanna Jensen, Travis S. Henry, Sung Min Ko, Arthur Stillman, Mohammad H. Rajaei, Kreton Mavromatis, Chandan Devireddy, Eric Sarin, Brad Leshnower, Robert Guyton, Brian Kaebnick, Vinod H. Thourani, Peter C. Block, Vasilis Babaliaros

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

OBJECTIVES: To evaluate the role of balloon annular sizing in transcatheter aortic valve replacement (TAVR). BACKGROUND: Multidetector cardiac computed tomography (MDCT) is the gold standard for aortic annular sizing in TAVR. Balloon sizing is increasingly used in patients with borderline annular size and severe calcification. A comparison between these two techniques is needed. METHODS: We retrospectively compared baseline characteristics and 30-day outcomes of patients undergoing balloon-expandable TAVR using annular MDCT or balloon sizing. Paravalvular leak (PVL) rates were compared adjusting for access site, valve generation, size, and valve calcification. RESULTS: A total of 205 patients underwent TAVR with MDCT (n ≤ 110) or balloon sizing (n ≤ 95). Balloon-sized patients were older (83 years vs 81 years; P≤.03), had more valve calcification (60.2% vs 30.9%; P<.001), and underwent more minimalist TAVR (61.1% vs 40%; P≤.03). Although we found no difference between balloon and MDCT sizing in rates of acute renal failure (3.2% vs 0.9%; P≤.34), annular rupture (1.1% vs 1.8%; P>.99), ≥ mild PVL by angiography (40% vs 35.5%; P≤.57), or 30-day transthoracic echocardiography (40.7% vs 29.3%; P≤.78), balloon-sized patients had a higher aortic regurgitation index (≥25) of 74.4% vs 54.1% (P≤.01). Thirty-day rates of ≥ moderate PVL were 7.0% with balloon and 5.7% with MDCT sizing (P≤.34). Balloon sizing recommended a different valve size in 34.0% of patients who underwent both methods (n ≤ 50). A different recommendation occurred more often in patients with moderate/severe annular calcification (50.0% vs 33.3%; P≤.01) and non-Tubular left ventricular outflow tracts (LVOTs) (70.6% vs 30.3%; P≤.01). CONCLUSION: Balloon sizing can be a complement to MDCT for annular sizing in TAVR, especially in patients with moderate/severe annular calcification, borderline annular size, and non-Tubular LVOT.

Original languageEnglish
Pages (from-to)295-304
Number of pages10
JournalJournal of Invasive Cardiology
Volume28
Issue number7
StatePublished - Jul 2016
Externally publishedYes

Keywords

  • annular sizing
  • aortic stenosis
  • balloon
  • computed tomography
  • transcatheter aortic valve replacement

Fingerprint

Dive into the research topics of 'Balloon Versus Computed Tomography Sizing of the Aortic Annulus for Transcatheter Aortic Valve Replacement and the Impact of Left Ventricular Outflow Tract Calcification and Morphology on Sizing'. Together they form a unique fingerprint.

Cite this