Calibrated balloon aortic valvuloplasty led to a strategy change in 22.6% of patients with incomplete or dubious non-invasive imaging prior to transcatheter aortic valve implantation.
Do MDCT and calibrated balloon aortic valvuloplasty improve the accuracy of aortic annulus sizing compared to TEE in TAVI candidates?
MDCT and calibrated balloon aortic valvuloplasty offer more accurate 3-dimensional assessment of the aortic annulus than 2-dimensional TEE, potentially reducing catastrophic complications during TAVI.
Transcatheter aortic valve implantation (TAVI) is a valuable alternative for aortic valve replacement in selected high-risk candidates. Accurate preoperative assessment of the aortic annular dimensions is crucial for the success of TAVI, since choice of an incorrectly sized prosthesis may result in catastrophic complications. These complications include annular rupture and coronary arterial obstruction, if the prosthesis is too big, or prosthesis migration and severe paravalvular leakage, if the prosthesis is too small. According to current recommendations, the choice of prosthesis size is based on transoesophageal echocardiography (TEE) measurements. However, TEE results are dependent on operator experience. Moreover, recent research has shown that TEE can significantly underestimate annular dimensional measurements. Alternative sizing methods based on Multidetector Computed Tomography (MDCT) or manometry during balloon aortic valvuloplasty have therefore been developed. We present a brief overview of the imaging modalities available for preoperative assessment of annular size and discuss their potential advantages and limitations.
Cerillo et al. (2012) conducted a review in Aortic stenosis (n=31). Calibrated balloon aortic valvuloplasty was evaluated on Strategy change (selection of a different size prosthesis or switch to conventional surgery). Calibrated balloon aortic valvuloplasty led to a strategy change in 22.6% of patients with incomplete or dubious non-invasive imaging prior to transcatheter aortic valve implantation.