Tailorizing pre-TAVI assessment: our experience with CT and MR protocols

Congress:

ECR 2020

Poster Number:

C-10631

Type:

Scientific Exhibit

Keywords:

Cardiac, Arteries / Aorta, Cardiovascular system, Catheter arteriography, CT-Angiography, MR-Angiography, Arterial access, Cost-effectiveness, Aneurysms, Blood, Cardiac Assist Devices, Retrospective, Observational, Performed at one institution

Authors:

F. Di Tosto¹, M. Chiocchi¹, L. Pugliese², F. Ricci², A. U. Cavallo¹, M. Forcina², V. De Stasio¹, M. Presicce¹, L. Spiritigliozzi², R. Floris¹; ¹Rome/IT, ²Roma/IT

DOI:

10.26044/ecr2020/C-10631

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-10631

Fig. 1: Reconstruction carried out through dedicated Workstation ADW4.7 GE with...

Fig. 2: Axial MRI image in the long axis of the aortic anulus diameter.

Fig. 3: Coronal MRI image in the long axis: distance from the right coronary ostium to...

Purpose

The aim of our study is to show the importance of precise evaluation of aortic anulus size, coronary ostia height, aortic valve shape and access vessels evaluation in patients undergoing Trans-catheter Aortic Valve Implantation (TAVI). These tools are fundamental in preprocedural evaluation and management of all kinds of TAVI candidates. We propose a tailored diagnostic tool considering the range of possible options, in particular ultra-low-dose contrast media injection protocol for Computed Tomography Angiography (CTA) or non contrastMagnetic Resonance Imaging (MRI) in the preproceduralevaluation of patients...

Methods and materials

Between June 2017 and January 2019, 323 patients with severe aortic stenosis, not eligible for surgery, were enrolled for TAVI at the Interventional Cardiology Department of Tor Vergata Polyclinic. All patients underwent preprocedural diagnostic examination: 218 patients without chronic kidney disease were examined by 128-slice CT system using a retrospectively ECG-triggered high-pitch spiral acquisition mode with low-dose radiation, other 105 patients with chronic kidney disease were divided in two groups: 78 patients with 30 ml/min < eGFR < 45 ml/min were studied by a CT...

Results

We monitored creatinine values in those 78 patients who underwent to the low dose contrast infusion CT protocol after 48 hours, 7 days after and 30 days after the scan. Within these patients only one manifested AKI and was promptly sent to thenephrologist for the appropriate treatment. No more complications were described in other patients. CT is the gold standard methodic for pre TAVI planning because allows accurate visualization and evaluation of the aortic annulus size, coronary ostia height, arterial calcifications, peripheral vascular accesses and...

Conclusion

From our experience in the preprocedural evaluation of TAVI candidates is fundamental to adapt each patient to the best protocol, in order to minimize possible complications and improve the quality of planning.

Personal information and conflict of interest

F. Di Tosto; Rome/IT - nothing to disclose M. Chiocchi; Rome/IT - nothing to disclose L. Pugliese; Rome/IT - nothing to disclose F. Ricci; Rome/IT - nothing to disclose A. U. Cavallo; Rome/IT - nothing to disclose M. Forcina; Rome/IT - nothing to disclose V. de Stasio; Rome/IT - nothing to disclose M. Presicce; Rome/IT - nothing to disclose L. Spiritigliozzi; Rome/IT - nothing to disclose R. Floris; Rome/IT - nothing to disclose

References

Holmes, D. R. et al. 2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement. Ann. Thorac. Surg. 93, 1340–1395 (2012). Achenbach, S. et al. SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR). J. Cardiovasc. Comput. Tomogr. 6, 366–380 (2012). Blanke, P. et al. Combined Assessment of Aortic Root Anatomy and Aortoiliac Vasculature With Dual-Source CT as a Screening Tool in Patients Evaluated for Transcatheter Aortic Valve Implantation. Am. J. Roentgenol. 195, 872–881 (2010). Nayak,...