Extrapolation of CT aortic annulus derived diameter/CT aortic annulus area from 2D echocardiography aortic annulus diameter in TAVR: not a reliable tool

Abstract Funding Acknowledgements Type of funding sources: None. Background Computed tomography (CT) aortic annulus area, CT area derived diameter and two-dimensional echocardiography (2D ECHO) diameters are used for valvular sizing in transcutaneous valve replacement (TAVR). According to our previous study, 2D ECHO was smaller comparison (22.6±2.9 vs 25.0±5.5mm, p = 0.013), but both diameter/CT predicted correct size selection with the same accuracy 79–80%. However, requires radiation iodine contrast administration, which might be limitation patients chronic kidney disease or history allergy. Purpose To determine if can reliable estimation area. Methods 139 consecutive favourable outcome Sapien XT/Sapien S3 TAVR (no more than mild regurgitation, only one implanted) were included study. measured from mid oesophageal three-chamber view (110–135°) just below anatomical annulus. obtained as double oblique plane by manual multiplanar reconstruction dataset, defined three lowest attachment points leaflets. Aortic tracking lumen contours, 2*√(area/π). Linear regression analysis between pre-implant performed; extrapolated [π*(d/2)2] calculated diameter. Concordance based on original determined where area/annulus falling outside overlap manufacturer recommended ranges neighbouring sizes. Results Significant relationship aera found (r=0.720, p<0.001, Fig 1,2). Extrapolated would have led inappropriate 33/100 cases (undersizing 16%, oversizing 17%), similar undersizing observed 18/106 (17%) parameters. Conclusion Extrapolation area/area is not a tool balloon expandable valve. In allergy, three-dimensional (3D) assessment remains viable alternative tool.