Key result
3D anatomy-guided TPVR valve selection shows poor-to-moderate interobserver agreement, performing worse in pediatric cases.
Why the study?
TPVR requires selecting optimal device type, size, and position, but anatomical shape variability may affect procedural planning.
Does the use of CMR-derived 3D patient-specific anatomical reconstructions achieve high interobserver agreement in selecting transcatheter pulmonary valve type and landing zone position among experienced interventional cardiologists for patients with repaired Tetralogy of Fallot?
Observational (n=60)
Blinded observers
No
Does the use of CMR-derived 3D patient-specific anatomical reconstructions achieve high interobserver agreement in selecting transcatheter pulmonary valve type and landing zone position among experienced interventional cardiologists for patients with repaired Tetralogy of Fallot?
Interobserver agreement for selecting transcatheter pulmonary valve type and landing zone using 3D CMR reconstructions is limited in pediatric patients and only moderate in adults, underscoring the need for standardized decision-support tools and broader regional access to diverse valve platforms.
Answers are grounded in this paper and cite their sources.
Limited agreement on 3D-based valve selection warrants clinical caution; leaves open need for standardized decision-support tools in congenital interventions.
Background Transcatheter pulmonary valve replacement (TPVR) requires selecting the optimal device type, size, and position. Variability in anatomical shape may affect procedural planning. Aim This study aimed to evaluate interobserver agreement (IOA) in TPVR device selection using 3D patient‐specific anatomies and explore a framework for determining agreement. Methods Six experienced observers from three regions of the Americas independently assessed valve type (self‐expanding [S‐E], balloon‐expandable [B‐E], surgical approach [SA]), size, and position for 60 3D reconstructed anatomies (pediatric and adult) derived from cardiac magnetic resonance images. Agreement was quantified using Cohen's and Fleiss' Kappa coefficients. Results and Discussion Overall, IOA was fair to moderate in the adult group and slight to fair in the pediatric group. Perfect agreement occurred in only eight cases, seven involving S‐E valves and one SA. S‐E valves were generally selected for anatomies with regular geometry but variable curvature, while SA valves were mainly chosen for markedly large or small anatomies. B‐E selections showed no consistent pattern. One consideration of this study is that not all transcatheter therapies were available across the regions, which may have influenced decision‐making. Additionally, interventionists typically rely on 2D imaging for procedural planning, and the use of 3D reconstructions without clinical data may also have influenced the results. Coronary anatomy was not included in the assessment. Conclusion Agreement in selecting TPVR devices is limited for the pediatric group but moderate for adults. Variation in preferences among observers highlights the need for equitable access to diverse valve solutions across different RVOT‐PA anatomies and demographic contexts.
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Pérez-Cualtán et al. (2026) conducted an observational in Repaired Tetralogy of Fallot with right ventricular outflow tract dysfunction (n=60). 3D patient-specific RVOT/PA anatomical assessment for TPVR device selection (adult vs. pediatric anatomy) vs. Pediatric cohort (vs. Adult cohort) was evaluated on Interobserver agreement (Cohen's and Fleiss' Kappa) for TPVR device type and landing zone position. Interobserver agreement for selecting transcatheter pulmonary valve type using 3D anatomies was fair-to-moderate in adults (mean kappa 0.38) but slight-to-fair in pediatrics (mean kappa 0.16).
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