Use of MDCT aortic root assessment to determine valve sizing in TAVI
Research type
Research Study
Full title
Use of 3-Dimensional Aortic Root Assessment by Multidetector Computed Tomography to Determine Valve Sizing in Transcatheter Aortic Valve Implantation
IRAS ID
189908
Contact name
Stephen Brecker
Contact email
Sponsor organisation
St George's University Hospitals NHS Foundation Trust
Duration of Study in the UK
1 years, 0 months, 0 days
Research summary
Aortic stenosis is a common disorder, affecting 10% of patients over the age of 80. This condition is associated with a long latency period, but once symptoms develop, there is rapid progression and 1-year mortality approaches 50% in untreated patients. Surgical aortic valve replacement (SAVR) is the preferred treatment modality for patients with severe symptomatic AS. However, many patients do not undergo SAVR due to the presence of significant comorbidities. Transcatheter aortic valve implantation (TAVI) is a well-established method to treat patients with severe AS with a prohibitive or high operative risk.\n\nThe incidence of aortic regurgitation post SAVR is very low. On the other hand, paravalvular leak (PVL) is frequent after TAVI, with moderate-to-severe PVL occurring in over 5% of cases. PVL is not well tolerated in patients with severe AS, as the left ventricle is typically non-compliant from left ventricular hypertrophy. PVL is an independent predictor of short and long-term mortality and associated with worse New York Heart Association functional class.\n\nCorrectly sizing the aortic annulus using high quality imaging data is critically important to minimising PVL. Multi-slice computed tomography (MDCT) has emerged as the preferred method to non-invasively size the aortic annulus. Inadequate transcatheter heart valve (THV) oversizing based on CT-derived aortic annular parameters has been shown to be strongly predictive of moderate-to-severe PVL. A multicentre, controlled trial has shown decreased rates of PVL using an MDCT aortic annular area sizing algorithm. \n\nThe major limitation of current research is that it is based solely upon the relationship between the THV and the aortic annulus, which oversimplifies the interaction between the THV and the aortic root. We plan to perform detailed MDCT assessments of the aortic root. We hypothesise that these detailed metrics will strongly predict PVL, and that they can be used to improve THV sizing.
REC name
London - London Bridge Research Ethics Committee
REC reference
16/LO/1135
Date of REC Opinion
5 Jul 2016
REC opinion
Favourable Opinion