Blinded re-analysis of CT-data with HeartNavigator®: Improved TAVI planning versus TEE and CT alone

C Schmidtke; D Richardt; M Strauch; J Barkhausen; HH Sievers; A Frydrychowicz

doi:10.1055/s-0032-1332517

The Thoracic and Cardiovascular Surgeon, Inhaltsverzeichnis

Blinded re-analysis of CT-data with HeartNavigator®: Improved TAVI planning versus TEE and CT alone

C Schmidtke ¹, D Richardt ¹, M Strauch ¹, J Barkhausen ², HH Sievers ¹, A Frydrychowicz ²

¹Klinik für Herz- und Thorakale Gefaesschirurgie, UKSH, Campus Lübeck, Lübeck, Germany
²Klinik für Radiologie und Nuklearmedizin, UKSH, Campus Lübeck, Lübeck, Germany

Abstract

Purpose: To retrospectively evaluate CT-based valve size determination using HeartNavigator® software (Philips Healthcare) in patients with previous transcatheter aortic valve implantation (TAVI) in comparison to preprocedural transesophageal echo (preTEE), implanted valve size, and postprocedural regurgitation severity.

Materials and methods: ECG-triggered CT data (73 ± 8% of ECG-cycle) from 19 patients who received TAVI procedures were retrospectively re-evaluated using HeartNavigator® (HN) after IRB-approval. Valve sizes were predicted applying vendor-recommended (Edward SAPIEN) valve size for HN-measured averaged annulus diameters (D_mean) or using the HN valve sizing option (HN-simulated). Results were compared preTEE. Patient-valve-mismatch was assessed by immediate postprocedural TEE (postTEE). Grading was performed on a 0 – 3 scale (0 = none, 1 = mild, 2 = moderate, 3 = severe).

Results: HN-measured annulus D_mean was significantly higher than TEE results (24.2 ± 2.0 mm vs. 20.4 ± 2.0 mm; p < 0.05; R²= 0.13). HN-measured and HN-simulated valve sizes matched implanted valve sizes in 13/19 and 10/19 cases, respectively. In the other cases, HN predominantly suggested larger valve diameters (HN-measured: 6 overestimated, HN-simulated: 6 over-, 3 underestimated). PostTEE showed no or mild regurgitation in all 19/19 cases (grades 0 and 1).

Conclusion: HeartNavigator® software subjectively facilitates valve sizing in TAVI procedural planning. Limited by a small sample size, available diastolic CT data only, and other parameters not taken into account (e.g., distance from annulus to coronary artery orifice, leaflet calcifications), HeartNavigator® is an asset worth further investigating.