Eastern Cardiothoracic Surgical Society

Preoperative Identification of Aortic Root Calcium Landmark on 3D CT Image on M2S Imaging Software Optimizes Valve Deployment in TAVR
Gilbert H L Tang, Amar Shah, Hasan Ahmad, Linda Cuomo, Martin Cohen, Tanya Dutta, Cenap Undemir, Andrea Cronin, Steven L. Lansman, Westchester Medical Center, Valhalla, NY

OBJECTIVE: Optimal TAVR valve positioning depends on accurately deploying the prosthesis with respect to a calcified landmark on the aortic valve. Preoperative 3D imaging of aortic root may help identify a calcium landmark best suited for this purpose and its ideal relationship to the prosthesis. Our study is to evaluate the M2S imaging software in preoperative planning for TAVR valve positioning.

METHODS: From 2/2013-6/2013, 19 patients (aged 83+/-8 years, 83% female) underwent TAVR with Edwards Sapien valve (11 TF, 8 TA). Preoperative determination of valve size was based on TTE and CT. Using 3D reconstruction of the aortic root generated by M2S, the extent and location of AV calcification is easily visualized, permitting identification of a convenient calcium landmark. Furthermore, a virtual Sapien valve can be generated and maneuvered to an optimal position within the AV annulus, displaying the relationship of the valve to the pre-selected calcium. These preoperative identifications were used intraoperatively. VARC2 outcomes were assessed.

RESULTS: Procedural success was 100%. In all cases, the pre-selected calcium landmark was identified and tracked, optimizing valve positioning and deployment (Figure). 30-day outcomes were: 1 out-of-hospital mortality from unknown cause, 1 out-of-hospital stroke, no MI, bleeding or access site complications and 17 patients had no or trivial paravalvular leak. 5 patients had new heart block requiring pacemaker. All had improved NYHA class symptoms and KCCQ-12 scores.

CONCLUSIONS: 3D CT reconstruction of the aortic root by M2S can identify a calcium landmark preoperatively that facilitates optimal valve positioning and deployment during TAVR.