Abstract
Background
Computed tomography (CT) imaging is the standard of care before transcatheter aortic
valve replacement (TAVR). The aortic annulus undergoes conformational changes during
the heart cycle. Therefore, the image acquisition time point can impact prosthesis
sizing and fit. Clinical outcome data are lacking. The aim of this study was to compare
systolic and diastolic cardiac CT data acquisition with regard to procedural and clinical
outcomes in patients undergoing TAVR for severe aortic stenosis (AS).
Methods
Preprocedural high-pitch helical CT datasets were analyzed in 1954 patients undergoing
TAVR between 2013 and 2018 at our center. Patients were stratified into two groups
according to the acquisition heart phase (979 systolic and 975 diastolic). The study
was approved by the local ethics committee.
Results
Median age was 81.6 [interquartile range 77.5–85.8] years and 964 (49.3%) patients
were male. No significant difference was found for the Valve Academic Research Consortium-3
(VARC-3) endpoints of technical failure (systolic, 5.1% vs. diastolic, 5.2%, p = 0.94)
or device failure (systolic, 13.7% vs. diastolic, 13.5%, p = 0.92). There was no
difference in paravalvular regurgitation. All-cause 30-day mortality was comparable
(systolic, 3.6% [95% confidence interval, 2.4–4.7%] vs. diastolic, 3.6% [2.4–4.8%],
p = 1.00), while 3-year mortality rates were higher in the diastolic group (Society
of Thoracic Surgeons score adjusted hazard ratio, 1.25 [1.07–1.46], p < 0.01).
Conclusions
While the 30-day technical and clinical outcomes after TAVR are comparable between
systolic and diastolic CT imaging, diastolic imaging was associated with higher long-term
mortality. Therefore, the data support the guideline recommendation of systolic imaging.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: May 19, 2022
Accepted:
May 14,
2022
Received in revised form:
May 3,
2022
Received:
November 23,
2021
Identification
Copyright
© 2022 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
