Multislice Computed Tomography for Prediction of Optimal Angiographic Deployment Projections During Transcatheter Aortic Valve Implantation》.pdf

J A C C : C A R D I O V A S C U L A R I N T E R V E N T I O N S V O L . 3 , N O . 1 1 , 2 0 1 0 © 2 0 1 0 B Y T H E A M E R I C A N C O L L E G E O F C A R D I O L O G Y F O U N D A T I O N I S S N 1 9 3 6 - 8 7 9 8 / $ 3 6 . 0 0 P U B L I S H E D B Y E L S E V I E R I N C . D O I : 1 0 . 1 0 1 6 / j . j c i n . 2 0 1 0 . 0 9 . 0 1 0 Multislice Computed Tomography for Prediction of Optimal Angiographic Deployment Projections During Transcatheter Aortic Valve Implantation Ronen Gurvitch, MBBS, David A. Wood, MD, Jonathon Leipsic, MD, Edgar Tay, MBBS, Mark Johnson, MBBS, Jian Ye, MD, Fabian Nietlispach, MD, Namal Wijesinghe, MD, Anson Cheung, MD, John G. Webb, MD Vancouver, British Columbia, Canada Objectives This study assessed whether multislice computed tomography (MSCT) could predict op- timal angiographic projections for visualizing the plane of the native valve and facilitate accurate positioning during transcatheter aortic valve implantation (TAVI). Background Accurate device positioning during TAVI depends on valve deployment in angio- graphic projections perpendicular to the native valve plane, but these may be difficult to determine. Methods Twenty patients underwent MSCT before TAVI. Using a novel technique, multiple an- giographic projections accurately representing the native valve plane in multiple axes were de- termined. The accuracy of all predicted projections was determined post-procedure using an- giography according to new criteria, based on valve perpendicularity and the degree of strut overlap (defined as excellent, satisfactory, or poor). The accuracy of valve deployment using MSCT was compared with the results of 20 consecutive patients undergoing TAVI without such MSCT angle prediction. Results Correct final deployment projections were more frequent in the MSCT-guided compared with non–MSCT-gui