3D Echocardiography versus 3D Reconstructive Computed Tomography Software for Optimal Sizing for TAVI

Objective: The increasing number of transcatheter aortic valve implantations (TAVI) has led to an increasing number of techniques for optimal aortic annulus sizing. Three dimensional transesophageal echocardiography (3TEE) and specialized TAVI software (e.g., 3mensio) for 3-dimensional reconstructive computed tomography (3RCT) have become standard in several institutions. In this study the accuracy of the two techniques was compared. Methods: Between 04/2008 and 09/2014, 1032 consecutive patients underwent TAVI. Since 09/2012 3TEE and since 04/2014 3RCT have been in clinical practice. In 37 (24 women) patients both aortic annulus sizing tools were used to allow a comparison. Seventeen patients underwent transapical, 16 patients transfemoral, and 4 patients transaortic valve implantation. Twenty-one Edwards Sapien valves, 6 CoreValves, 5 Portico,3 DirectFlow and 2 JenaValves were implanted. The EuroScore I was 32% (range: 5–97), EuroScore II: 16% (range: 1–89), and STS PROM Score: 9.9% (range: 2–64). Results: Technical success rate was 100%. Whereas in 3TEE the mean annulus area was 454 mm2 (range: 270–930) with an area derived diameter of 23.8 mm (range: 19–34) and the mean perimeter 77 mm (range 61–115) with a perimeter derived diameter of 24.6 mm (range: 19–36.6), in 3RCT the mean area was 427 mm2 (range: 319–616) with an area derived diameter of 23 mm (range: 20.4–29) and the mean perimeter 80.8 mm (range 21.5–98) with an perimeter derived diameter of 23.6 mm (range: 20.5–28.5). The mean difference between 3TEE and 3RCT derived diameter was 0.54 mm and the mean difference between 3TEE and 3RCT derived perimeter was 0.55 mm. Conclusions: The introduction of both tools allows perfect sizing of the virtual aortic annulus. 3RCT is a precise tool for optimal sizing with no examiner dependent variations. On the other hand, especially in patients with contraindication for computed tomography (e.g., urgent cases, kidney failure), 3TEE is a precise alternative.