Why the study?
MSCT is the gold-standard approach for prosthesis sizing before TAVI, but whether conventional aortic root angiography alone can reliably facilitate valve selection and its inter-reader variability were unknown.
Does conventional aortic root angiography reliably facilitate valve selection compared to MSCT in patients undergoing TAVI?
Does conventional aortic root angiography reliably facilitate valve selection compared to MSCT in patients undergoing TAVI?
Conventional aortic root angiography shows only modest agreement with MSCT for TAVI prosthesis sizing and should be reserved for cases where MSCT and TEE are unavailable.
Answers are grounded in this paper and cite their sources.
Modest CA-MSCT agreement limits routine angiography sizing; leaves open selective use where MSCT unavailable.
Background: The gold-standard approach to prosthesis sizing before transcatheter aortic valve implantation (TAVI) is multislice computed tomography (MSCT). We aimed to investigate whether conventional aortic root angiography (CA) alone can reliably facilitate valve selection and to describe its inter-reader variability. Methods: Five TAVI specialists (3 interventional cardiologists and 2 cardiac surgeons) independently reviewed preprocedural CAs for 50 patients implanted with the Edwards SAPIEN 3 valve. Results: The prosthesis size selected based on visual CA appraisal matched that based on MSCT in 60% of cases (range: 50%-68%), with undersizing in 11% (4%-33%) and oversizing in 29% (10%-46%; p=0.187 for equality of the proportions test). Agreement between CA-based and MSCT-based valve selection was moderate (K=0.41; Kw=0.61). Reassessment of choice following awareness of the annulus long-axis diameter did not significantly improve this agreement (0.40 and 0.63, respectively), though more undersizing (14%) and less oversizing (25%) occurred. Correct valve selection was more common in interventional cardiologists than cardiac surgeons (66% vs 53%; p=0.0391), who made more oversizing errors. Conclusions: There is a modest agreement between CA-based and MSCT-based SAPIEN 3 selection. Although the former should not be performed routinely, it may be informative in settings where MSCT and transoesophageal echocardiography are unavailable.
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Gansera et al. (2019) studied this question.
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