Eastern Cardiothoracic Surgical Society

CT Annular Measurements of the Aortic Valve by M2S Software Provide Optimal Sizing and Valuable Preoperative Case Planning Information in TAVR
Gilbert H L Tang, Amar Shah, Tanya Dutta, Andrea Cronin, Hasan Ahmad, Linda Cuomo, Martin Cohen, Cenap Undemir, Steven L. Lansman, Westchester Medical Center, Valhalla, NY

OBJECTIVE: Optimal TAVR valve sizing is critical to minimize paravalvular leak (PVL) and root complications. CT-based annular sizing may be superior to TEE with added advantages of anatomical landmarks available for software-based preoperative case planning. Our study is to evaluate the M2S software as a valid tool for CT annular sizing for TAVR.

METHODS: From 12/2012-6/2013, 28 consecutive patients (aged 84+/-8 years, 68% female) underwent TTE and 64- or 256-slice CT for evaluation of TAVR with 23- or 26-mm Edwards Sapien valve. 3D aortic root measurements including annular area determined by our radiologist were prospectively compared with M2S imaging software. VARC2 outcomes were assessed.

RESULTS: M2S was able to process all CT studies except one due to motion artifact. Two studies had significant discrepancies with aortic valve annular area due to severe annular calcification and inadequate contrast in aortic root. Remaining 25 studies had highly correlated AV annular areas (R2 = 0.93) with only 1 discrepancy in Sapien valve size recommendation (Figure). Procedural success was 100% in 19 eligible patients. 30-day outcomes were: 1 out-of-hospital death from unknown cause, 1 out-of-hospital stroke from subtherapeutic INR for AF, no MI, bleeding or access site complications and 17 had no or trivial PVL.

CONCLUSIONS: 3D CT aortic root measurements by M2S accurately determines Sapien valve size and provides new TAVR programs with valuable preoperative case planning information.