TCT-865 Rotational Aortography With CT Reconstruction Can Guide Transcatheter Aortic Valve Replacement And Predict Prosthetic Regurgitation

Abstract

Background: The Dyna-CT and Aortic Valve Guide software (Siemens) perform background 3D reconstruction of rotational root aortography, automatically segment the valve, and display the resulting CT as an overlay on live fluoroscopy during Transcatheter Aortic Valve Replacement (TAVR). We hypothesized that the dimensions of a circle around the nadir of the native valve cusps would predict whether the TAVR device was of adequate size to prevent aortic insufficiency (AI). Methods: 20 patients had rotational aortography during rapid pacing prior to TAVR with the Edwards-Sapien device. Images were analyzed in 3D and planar views. The annulus plane was retrospectively determined (Figure) at the nadir of the three contrast filled native valve cusps (L, R, N). The smallest circle encompassing the outer edge of the native cusps' nadir (CN) was compared to the modeled circular 23 or 26mmprosthetic valve (V) implanted. The ratio of areas (V:CN) was plotted against 30d post TAVR echocardiographic AI (0=no AI, 1=trace, 2=mild, 3=moderate, 4=severe AI). Results: All patients tolerated rapid pacing and root aortography prior to TAVR. The 3-D CT image was used to determine an ideal radiographic projection angle for implantation; the overlay on live fluoroscopy aided positioning of the TAVR. The ratio of V:CN was inversely correlated with echocardiographic AI (r= -0.685; p<0.01). Conclusions: Rotational aortography with CT reconstruction is feasible and can guide TAVR. Sizing at the nadir of the native valve cusps may be a useful modality complementary to transesophageal echocardiography for implant sizing to reduce prosthetic AI. (Figure Presented) .