Department of Cardiology, Klinikum Augsburg, Herzzentrum Augsburg-Schwaben, Augsburg, Germany.
USBBU, Unabhängige statistische Beratung, Munich, Germany.
Open Heart. 2019 Dec 29;6(2):e001201. doi: 10.1136/openhrt-2019-001201. eCollection 2019.
The gold-standard approach to prosthesis sizing before transcatheter aortic valve implantation (TAVI) is multislice computed tomography (MSCT). We aimed to investigate whether conventional aortic root angiography (CA) alone can reliably facilitate valve selection and to describe its inter-reader variability.
Five TAVI specialists (3 interventional cardiologists and 2 cardiac surgeons) independently reviewed preprocedural CAs for 50 patients implanted with the Edwards SAPIEN 3 valve.
The prosthesis size selected based on visual CA appraisal matched that based on MSCT in 60% of cases (range: 50%-68%), with undersizing in 11% (4%-33%) and oversizing in 29% (10%-46%; p=0.187 for equality of the proportions test). Agreement between CA-based and MSCT-based valve selection was moderate (K=0.41; Kw=0.61). Reassessment of choice following awareness of the annulus long-axis diameter did not significantly improve this agreement (0.40 and 0.63, respectively), though more undersizing (14%) and less oversizing (25%) occurred. Correct valve selection was more common in interventional cardiologists than cardiac surgeons (66% vs 53%; p=0.0391), who made more oversizing errors.
There is a modest agreement between CA-based and MSCT-based SAPIEN 3 selection. Although the former should not be performed routinely, it may be informative in settings where MSCT and transoesophageal echocardiography are unavailable.
经导管主动脉瓣植入术（TAVI）前，金标准的假体尺寸选择方法是多排螺旋 CT（MSCT）。我们旨在研究单纯常规主动脉根部造影（CA）是否能可靠地促进瓣膜选择，并描述其读者间的可变性。
5 名 TAVI 专家（3 名介入心脏病专家和 2 名心脏外科医生）独立分析了 50 例植入 Edwards SAPIEN 3 瓣膜患者的术前 CA。
基于视觉 CA 评估选择的假体尺寸与基于 MSCT 的尺寸匹配率为 60%（范围：50%-68%），其中低估 11%（4%-33%），高估 29%（10%-46%；p=0.187，比例检验）。CA 与 MSCT 基础上的瓣膜选择之间的一致性为中等（K=0.41；Kw=0.61）。在了解瓣环长轴直径后重新评估选择，并未显著提高这种一致性（分别为 0.40 和 0.63），尽管低估（14%）和高估（25%）的情况更多。介入心脏病专家的正确瓣膜选择比心脏外科医生更常见（66% vs 53%；p=0.0391），他们更易出现高估错误。
CA 与 MSCT 基础上的 SAPIEN 3 选择之间存在中等程度的一致性。虽然前者不应该常规进行，但在无法进行 MSCT 和经食管超声心动图的情况下，它可能具有信息性。
